Name of Charity
Address
Telephone number
Co-ordinator Name
Co-ordinator Email address
Charity website address
Purpose of Charity
Registered Charity Number	Charity founded in which year ?
Please write in 3 sentences how your charity would benefit from coaching (N.B. this is how we will prioritise the charities' waiting list, so make it powerful!)
Please state which service you are most interested in
Individual Leadership Coaching     Team coaching