Coaching Questionnaire Survey

1. Personal Information
(strictly confidential)

Personal Information (strictly confidential) Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

2. Birthday

Birthday

3. Do you currently own a Business?

Do you currently own a Business? Yes

4. If you answered yes to owning your own business and are looking for coaching to market your business online, please check off any of the following internet sites you currently have.

If you answered yes to owning your own business and are looking for coaching to market your business online, please check off any of the following internet sites you currently have. Website

Blog

Main Capture Page

Facebook Profile

Facebook Fanpage

You Tube Channel

5. Please explain any experience you've had as an entrepreneur.

Also, please list your greatest accomplishments and greatest frustrations.

Please explain any experience you've had as an entrepreneur. Also, please list your greatest accomplishments and greatest frustrations.

6. How do you rank your communication skills?

	Below Average	Average	Above Average	Excellent
Oral	*How do you rank your communication skills? Oral Below Average	Oral Average	Oral Above Average	Oral Excellent
Written	Written Below Average	Written Average	Written Above Average	Written Excellent

7. How would you rank your internet skills?
Please answer honestly - when I began online I was extremely technologically challenged!

	I only know how to turn on the computer	Below Average	Average	Above Average	Excellent
Logging on and updating Social Media Sites	*How would you rank your internet skills? Please answer honestly - when I began online I was extremely technologically challenged! Logging on and updating Social Media Sites I only know how to turn on the computer	Logging on and updating Social Media Sites Below Average	Logging on and updating Social Media Sites Average	Logging on and updating Social Media Sites Above Average	Logging on and updating Social Media Sites Excellent
Wordpress	Wordpress I only know how to turn on the computer	Wordpress Below Average	Wordpress Average	Wordpress Above Average	Wordpress Excellent
Links	Links I only know how to turn on the computer	Links Below Average	Links Average	Links Above Average	Links Excellent
Making Videos	Making Videos I only know how to turn on the computer	Making Videos Below Average	Making Videos Average	Making Videos Above Average	Making Videos Excellent
Uploading Videos	Uploading Videos I only know how to turn on the computer	Uploading Videos Below Average	Uploading Videos Average	Uploading Videos Above Average	Uploading Videos Excellent
Building Capture Pages	Building Capture Pages I only know how to turn on the computer	Building Capture Pages Below Average	Building Capture Pages Average	Building Capture Pages Above Average	Building Capture Pages Excellent
Creating auto-responders/broadcast emails	Creating auto-responders/broadcast emails I only know how to turn on the computer	Creating auto-responders/broadcast emails Below Average	Creating auto-responders/broadcast emails Average	Creating auto-responders/broadcast emails Above Average	Creating auto-responders/broadcast emails Excellent

8. What do you envision your future to be like as it pertains to marketing a business online?

What do you envision your future to be like as it pertains to marketing a business online?

9. Please rank your skills as they pertain to the following:

	Never heard of	Heard of but not familiar with	A little experience with	A lot of experience with	Expert at
Facebook	*Please rank your skills as they pertain to the following: Facebook Never heard of	Facebook Heard of but not familiar with	Facebook A little experience with	Facebook A lot of experience with	Facebook Expert at
You Tube	You Tube Never heard of	You Tube Heard of but not familiar with	You Tube A little experience with	You Tube A lot of experience with	You Tube Expert at
Vimeo	Vimeo Never heard of	Vimeo Heard of but not familiar with	Vimeo A little experience with	Vimeo A lot of experience with	Vimeo Expert at
Pixel Pipe	Pixel Pipe Never heard of	Pixel Pipe Heard of but not familiar with	Pixel Pipe A little experience with	Pixel Pipe A lot of experience with	Pixel Pipe Expert at
Traffic Geyser	Traffic Geyser Never heard of	Traffic Geyser Heard of but not familiar with	Traffic Geyser A little experience with	Traffic Geyser A lot of experience with	Traffic Geyser Expert at
Tube Blaster	Tube Blaster Never heard of	Tube Blaster Heard of but not familiar with	Tube Blaster A little experience with	Tube Blaster A lot of experience with	Tube Blaster Expert at
Tube Mogul	Tube Mogul Never heard of	Tube Mogul Heard of but not familiar with	Tube Mogul A little experience with	Tube Mogul A lot of experience with	Tube Mogul Expert at
Twitter	Twitter Never heard of	Twitter Heard of but not familiar with	Twitter A little experience with	Twitter A lot of experience with	Twitter Expert at
Tweet Deck	Tweet Deck Never heard of	Tweet Deck Heard of but not familiar with	Tweet Deck A little experience with	Tweet Deck A lot of experience with	Tweet Deck Expert at
Linked In	Linked In Never heard of	Linked In Heard of but not familiar with	Linked In A little experience with	Linked In A lot of experience with	Linked In Expert at
Wordpress	Wordpress Never heard of	Wordpress Heard of but not familiar with	Wordpress A little experience with	Wordpress A lot of experience with	Wordpress Expert at
Aweber or Get Response	Aweber or Get Response Never heard of	Aweber or Get Response Heard of but not familiar with	Aweber or Get Response A little experience with	Aweber or Get Response A lot of experience with	Aweber or Get Response Expert at
Blogging	Blogging Never heard of	Blogging Heard of but not familiar with	Blogging A little experience with	Blogging A lot of experience with	Blogging Expert at
Bit.ly	Bit.ly Never heard of	Bit.ly Heard of but not familiar with	Bit.ly A little experience with	Bit.ly A lot of experience with	Bit.ly Expert at
Website Management	Website Management Never heard of	Website Management Heard of but not familiar with	Website Management A little experience with	Website Management A lot of experience with	Website Management Expert at
Company Replicated Site	Company Replicated Site Never heard of	Company Replicated Site Heard of but not familiar with	Company Replicated Site A little experience with	Company Replicated Site A lot of experience with	Company Replicated Site Expert at
Ezine or Article sites	Ezine or Article sites Never heard of	Ezine or Article sites Heard of but not familiar with	Ezine or Article sites A little experience with	Ezine or Article sites A lot of experience with	Ezine or Article sites Expert at
Forums/Chat Rooms	Forums/Chat Rooms Never heard of	Forums/Chat Rooms Heard of but not familiar with	Forums/Chat Rooms A little experience with	Forums/Chat Rooms A lot of experience with	Forums/Chat Rooms Expert at
Google adwords	Google adwords Never heard of	Google adwords Heard of but not familiar with	Google adwords A little experience with	Google adwords A lot of experience with	Google adwords Expert at
Facebook advertising	Facebook advertising Never heard of	Facebook advertising Heard of but not familiar with	Facebook advertising A little experience with	Facebook advertising A lot of experience with	Facebook advertising Expert at
Meetup.com	Meetup.com Never heard of	Meetup.com Heard of but not familiar with	Meetup.com A little experience with	Meetup.com A lot of experience with	Meetup.com Expert at
Microniche finder	Microniche finder Never heard of	Microniche finder Heard of but not familiar with	Microniche finder A little experience with	Microniche finder A lot of experience with	Microniche finder Expert at
Wordpot	Wordpot Never heard of	Wordpot Heard of but not familiar with	Wordpot A little experience with	Wordpot A lot of experience with	Wordpot Expert at
My Space	My Space Never heard of	My Space Heard of but not familiar with	My Space A little experience with	My Space A lot of experience with	My Space Expert at
Squidoo	Squidoo Never heard of	Squidoo Heard of but not familiar with	Squidoo A little experience with	Squidoo A lot of experience with	Squidoo Expert at
PPC	PPC Never heard of	PPC Heard of but not familiar with	PPC A little experience with	PPC A lot of experience with	PPC Expert at
SEO	SEO Never heard of	SEO Heard of but not familiar with	SEO A little experience with	SEO A lot of experience with	SEO Expert at
Ning.com	Ning.com Never heard of	Ning.com Heard of but not familiar with	Ning.com A little experience with	Ning.com A lot of experience with	Ning.com Expert at

10. Please tell me anything else I should know that will help customize our coaching.

Please tell me anything else I should know that will help customize our coaching.

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