HIGH PERFORMANCE QUESTIONNAIRE
Source: This tool is based on proprietary concepts from High Performance Institute's Certified High Performance Coach Program. Do not duplicate without permission.

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* 1. Contact Information

Full Name (First Name, Surname)

Country (you currently reside in)

Email Address

Phone Number

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* 2. What is your gender?

Female

Male

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* 3. Please briefly describe why you are interested in High Performance:

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* 4. On a scale from 1 (lowest) to 10 (highest), please rate yourself in the following areas of your life.

	1	2	3	4	5	6	7	8	9	10
Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life?	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 1	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 2	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 3	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 4	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 5	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 6	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 7	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 8	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 9	Clarity: do you feel you are clear about who you are, your purpose, and the direction you want to go in life? 10
Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy?	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 1	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 2	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 3	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 4	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 5	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 6	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 7	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 8	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 9	Energy: do you consistently have enough mental and physical energy needed to excel, accomplish your goals, and feel motivated and happy? 10
Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world?	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 1	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 2	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 3	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 4	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 5	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 6	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 7	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 8	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 9	Courage: do you take action and consistently express who you truly are and what you truly think, need, and desire with the world? 10
Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities?	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 1	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 2	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 3	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 4	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 5	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 6	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 7	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 8	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 9	Productivity: are you consistently focused and effective, and are you good at minimising distractions and maintaining priorities? 10
Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals?	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 1	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 2	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 3	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 4	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 5	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 6	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 7	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 8	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 9	Influence: do you feel you have the social influence with your family, friends and team needed to accomplish your goals? 10

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50% of survey complete.