We're excited to have you onboard. Please complete this form to help us personalize your learning journey.
Full Name *
Mobile Number *
Email Address *
Date of Birth *
State *Select your stateAndhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar Haveli and Daman and DiuDelhiJammu and KashmirLadakhLakshadweepPuducherry
Age *
What is your highest qualification? *Select your highest qualification10th12thDiplomaGraduatePost GraduateDoctorate (PhD)Other
What is your educational background? *
How many years of professional experience do you have? *Select your experience0-1 Years1-3 Years3-5 Years5-10 Years10+ Years
Which best describes your current role? *Select your current roleDoctorNutritionist/DietitianPsychologistPhysiotherapistNursePharmacistFitness ProfessionalYoga PractitionerCorporate ProfessionalEntrepreneurHomemakerStudentOthers
What inspired you to enroll in the Global Health Coach Certification Program? *
What are your primary goals after completing the certification? *
How confident do you currently feel about your coaching skills? *
Scale: 1 (Not confident) → 10 (Very confident)
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Have you previously worked with clients, patients, or groups in a coaching, healthcare, wellness, or counselling capacity? *YesNo
Have you attended any coaching or wellness certification before? *YesNo
If yes, where did you complete it? *
What are you most excited to learn during this program? *
Is there any specific support you would like from the Weljii team during your learning journey? *