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Apply to be a GFFS Coach
3
Basic Information
Name
First
Last
Email
Phone
Cell / Home / Work
Address
Street
City
State / Province / Region
Postal Code
Please select...
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Republic of the
Congo, Democratic Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
The Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City (Holy See)
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
CURRENT EMPLOYER
Company Name
DATES EMPLOYED
Start Date
End Date (Select today's date if still employed)
GLUTEN-FREE KNOWLEDGE
DO YOU LIVE A GLUTEN-FREE LIFESTYLE?
Yes
No
HOW LONG HAVE YOU LIVED GLUTEN-FREE?
WHERE HAVE YOU FOUND THE BEST INFORMATION ABOUT GLUTEN-FREE LIVING?
IF YOU ARE LIVING A GLUTEN-FREE LIFESTYLE, DO YOU HAVE A WEBSITE RELATED TO IT?
Yes
No
WHAT IS THE WEBSITE?
IF YOU LIVE A GLUTEN FREE LIFESTYLE, DO YOU USE SOCIAL MEDIA TO PROMOTE YOUR GLUTEN FREE LIFESTYLE?
Yes
No
FACEBOOK
Please include link for promoting Gluten Free lifestyle
TWITTER
Please include link for promoting Gluten Free lifestyle
INSTAGRAM
Please include link for promoting Gluten Free lifestyle
PINTEREST
Please include link for promoting Gluten Free lifestyle
ARE YOU A GLUTEN INTOLERANCE GROUP BRANCH MEMBER/SUPPORT GROUP MEMBER?
Yes
No
DO YOU RUN THE BRANCH YOU ARE A MEMBER WITH?
Yes
No
DO YOU CURRENTLY WORK WITH CLIENTS AS A DIETITIAN, PERSONAL CHEF OR MEDICAL PROFESSIONAL?
Yes
No
WHAT ARE YOUR CREDENTIALS?
(eg.; MD, ND, RD, LCSW, RN, CC, CSC, CCC, CEC etc.)
DO YOU OWN/OPERATE/MANAGE A FOOD SERVICE BUSINESS?
Yes
No
(eg.; restaurant, personal chef, food truck, bakery, café, etc.)
WHAT IS THE NAME OF YOUR FOOD SERVICE BUSINESS?
PLEASE BRIEFLY DESCRIBE YOUR FOOD SERVICE BUSINESS:
ARE YOU SERVSAFE CERTIFIED?
Yes
No
HAVE YOU EVER HELPED SOMEONE NEW TO THE GLUTEN-FREE LIFESTYLE THROUGH THE INITIAL LEARNING PROCESS?
Yes
No
IN 300 WORDS OR LESS WHY DO YOU WANT TO BECOME A GFFS COACH?
PLEASE PROVIDE CONTACT INFORMATION FOR THE FOLLOWING TWO REFERENCES:
Professional Reference
(Examples might include a work supervisor, a professor, or someone with whom you have done volunteer work. Anyone who is familiar with your work in a professional setting)
First Name
Last Name
Email
Relationship to Applicant
Gluten-free Lifestyle Reference
(Anyone who is familiar with your experience living gluten-free)
First Name
Last Name
Email
Relationship to Applicant
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