WIAL Gives Back – Supporting Global Recovery

My name *

First

Last

My email *

My country of residence *

I am a … *

My WIAL Action Learning coaching experience *

When it comes to virtual Action Learning sessions I /I am *

I can play the role of an Action Learning coach in the following languages: *

(required)

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(optional)

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(optional)

I am willing to contribute to the WIAL Gives Back program approximately *

for a total of *

Any additional remarks

I prefer to contribute to a project (select all that apply): *

in my own country
at a global scale

Thank you for your interest in supporting the WIAL Gives Back – Supporting Global Recovery program. There will be a limited number of coaching opportunities and we will do our utmost best to accommodate all the WIAL Action Learning coaches who sign up and match these with the needs expressed by the potential beneficiaries.

Personal Data *

Personal Data *

You acknowledge and agree that we may use your personal information consistent with our privacy policy and that we may share your information with the international WIAL organization and other WIAL Affiliates. Once you are certified as a coach or partner, you authorize us to post your contact information, and the photo, company name, title, website address, curriculum vitae or brochure, affiliation, credentials, bio and other similar information that you provide to us on WIAL directories and in other WIAL materials or communications, listing you as a coach or partner, as applicable.