Presenter’s application form

for those who have been invited or would like to take on the role of a speaker/presenter at an ICF Poland event

Please fill in the form.

Email address *

Name and surname *

Profession/ field of expertise *
coachpsychologisttrainerpsychotherapistmentorother

Form of the presentation: *
workshopspeech/lecturein persononline (Skype / Zoom)

Title of the presentation *

Current ICF accreditation *
ACCPCCMCCnone

Presenter’s description for publication (100 words maximum) *

I attach my picture for publication (1MB maximum) *

Presentation description (200 words maximum) *

I declare that my presentation and accompanying materials are the result of my own work and/ or I am authorized to present or use them in whole or in parts, as well as my presentation does not breach any third party copyright, property or ownership rights. *
yesno

I understand and accept that I will not be paid in any form for the presentation. Any arising costs (e.g. travel expenses) may be reimbursed only after a previous written consent from an authorized representative of ICF Chapter Poland. *
yesno

I hereby agree to distribution or publication of my picture and texts provided above by ICF Chapter Poland in relation to my presentation. *
yesno

Anything else you would like to share. (100 words maximum)



Please fill in the form so that we can apply towards CCE units (as a Chapter)


1) Date of Educational Offering:

2) Name of primary speaker/facilitator?

3) Credential status of the primary speaker/facilitator?
ACCPPCMCCCurrently pursuing an ICF Credential (after PCC course – ACTP)Not currently pursuing an ICF Credential

4) Name of additional speakers/facilitators (if any)?

5) Title for this educational offering:

6) How many hours will the educational offering last?

7) Which delivery method will be used ? (only live interaction will be approved no
recordings)
InpersonTeleclass / PhoneWebinar / Live Web Based

8) Core Competencies and Resource Development. Education in skills that may be useful to a coach is Resource Development; education in using those skills as a coach is Core Competencies.
Please describe the learning objectives and specific subjects that will be covered in this educational offering and the core competencies that are applied.

1. Meeting Ethical Guidelines and Professional Standards

2. Establishing the Coaching Agreement

3. Establishing Trust and Intimacy with the Client

4. Coaching Presence

9) What percentage of the educational offering time is devoted to training directly related to ICF Core Competencies (instruction on coaching skills or ethics, or applying technical skills or ethics, or applying technical skills as a coach)?
25%50%75%100%



* - mandatory fields