Name: Mary Ann Pilotte

HRSA Rural Health
Network Development Program
Executive Coaching Program: Pre-Coaching Form
This form is to be completed by the coachee before the scheduled coaching session. The
form should be emailed to their assisted coach at least one day before the scheduled
session and earlier if possible.
Coachee’s Name:
Coach’s Name and Phone Number:
Coaching Session Date:
Coaching Session Time:
(Time Zone)
What do I expect to accomplish during this call?
Since our last call what are my biggest successes?
What didn't I get done, but had planned to do?
What challenges kept me awake since we talked last?
What opportunities are currently available?
I promise to do the following by the next call (to be completed at the end of each
©NCHN 2013