Intake Assessment

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* 1. Personal Information

First Name

Last Name

Email Address

Mobile Number

Personal Email

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* 2. Briefly describe your role.

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* 3. List your team members and their titles/roles.

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* 4. When you are not available, which person on your team is available to help answer questions that we may have?

First Name

Last Name

eMail Address

Phone

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* 5. What are your top 3 goals as an ELITE member?

Goal 1

Goal 2

Goal 3

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* 6. What are the top three things you would be able to contribute to other ELITES?

First

Second

Third

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* 7. When considering how a coach can interact with you, how important is it for a coach to...

	Very Important	Somewhat Important	Neutral	Not important	I don't want this
Help you explore and understand what is holding you back?	Help you explore and understand what is holding you back? Very Important	Help you explore and understand what is holding you back? Somewhat Important	Help you explore and understand what is holding you back? Neutral	Help you explore and understand what is holding you back? Not important	Help you explore and understand what is holding you back? I don't want this
Gain insight into who you are, your strengths, capabilities and potential?	Gain insight into who you are, your strengths, capabilities and potential? Very Important	Gain insight into who you are, your strengths, capabilities and potential? Somewhat Important	Gain insight into who you are, your strengths, capabilities and potential? Neutral	Gain insight into who you are, your strengths, capabilities and potential? Not important	Gain insight into who you are, your strengths, capabilities and potential? I don't want this
Provide encouragement and support?	Provide encouragement and support? Very Important	Provide encouragement and support? Somewhat Important	Provide encouragement and support? Neutral	Provide encouragement and support? Not important	Provide encouragement and support? I don't want this
Help you define your goals?	Help you define your goals? Very Important	Help you define your goals? Somewhat Important	Help you define your goals? Neutral	Help you define your goals? Not important	Help you define your goals? I don't want this
Help you identify actions and next steps?	Help you identify actions and next steps? Very Important	Help you identify actions and next steps? Somewhat Important	Help you identify actions and next steps? Neutral	Help you identify actions and next steps? Not important	Help you identify actions and next steps? I don't want this
Challenge you with difficult questions?	Challenge you with difficult questions? Very Important	Challenge you with difficult questions? Somewhat Important	Challenge you with difficult questions? Neutral	Challenge you with difficult questions? Not important	Challenge you with difficult questions? I don't want this
Provide honest and direct feedback?	Provide honest and direct feedback? Very Important	Provide honest and direct feedback? Somewhat Important	Provide honest and direct feedback? Neutral	Provide honest and direct feedback? Not important	Provide honest and direct feedback? I don't want this
Make you accountable for your goals?	Make you accountable for your goals? Very Important	Make you accountable for your goals? Somewhat Important	Make you accountable for your goals? Neutral	Make you accountable for your goals? Not important	Make you accountable for your goals? I don't want this

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* 8. Please answer the following (please enter the full amount; e.g. $250K should be entered as 250000):

Income Goal:

Average Loan Amount:

Average commission (basis points):

% of Pre-Qual Conversations that result in applications submitted to processing:

% of applications that result in personal funding:

This year's Units funded goal:

This year's $ funded goal:

Last year's units:

Last year's $ funded amount:

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* 9. Evaluate how each area of your life is working?

	Couldn't be better!	Doing well!	Neutral	Could be better.	Yikes!	Can't answer
How is your life working?	How is your life working? Couldn't be better!	How is your life working? Doing well!	How is your life working? Neutral	How is your life working? Could be better.	How is your life working? Yikes!	How is your life working? Can't answer
How are you doing spiritually?	How are you doing spiritually? Couldn't be better!	How are you doing spiritually? Doing well!	How are you doing spiritually? Neutral	How are you doing spiritually? Could be better.	How are you doing spiritually? Yikes!	How are you doing spiritually? Can't answer
How are you doing as a Wife/Husband?	How are you doing as a Wife/Husband? Couldn't be better!	How are you doing as a Wife/Husband? Doing well!	How are you doing as a Wife/Husband? Neutral	How are you doing as a Wife/Husband? Could be better.	How are you doing as a Wife/Husband? Yikes!	How are you doing as a Wife/Husband? Can't answer
How are you doing as a Father/Mother?	How are you doing as a Father/Mother? Couldn't be better!	How are you doing as a Father/Mother? Doing well!	How are you doing as a Father/Mother? Neutral	How are you doing as a Father/Mother? Could be better.	How are you doing as a Father/Mother? Yikes!	How are you doing as a Father/Mother? Can't answer
How are you doing as a Son/Daughter?	How are you doing as a Son/Daughter? Couldn't be better!	How are you doing as a Son/Daughter? Doing well!	How are you doing as a Son/Daughter? Neutral	How are you doing as a Son/Daughter? Could be better.	How are you doing as a Son/Daughter? Yikes!	How are you doing as a Son/Daughter? Can't answer
How are you doing as an overall family uint?	How are you doing as an overall family uint? Couldn't be better!	How are you doing as an overall family uint? Doing well!	How are you doing as an overall family uint? Neutral	How are you doing as an overall family uint? Could be better.	How are you doing as an overall family uint? Yikes!	How are you doing as an overall family uint? Can't answer
How are you doing with your physical body?	How are you doing with your physical body? Couldn't be better!	How are you doing with your physical body? Doing well!	How are you doing with your physical body? Neutral	How are you doing with your physical body? Could be better.	How are you doing with your physical body? Yikes!	How are you doing with your physical body? Can't answer
How are you doing with your diet?	How are you doing with your diet? Couldn't be better!	How are you doing with your diet? Doing well!	How are you doing with your diet? Neutral	How are you doing with your diet? Could be better.	How are you doing with your diet? Yikes!	How are you doing with your diet? Can't answer
How are you doing with your presented image?	How are you doing with your presented image? Couldn't be better!	How are you doing with your presented image? Doing well!	How are you doing with your presented image? Neutral	How are you doing with your presented image? Could be better.	How are you doing with your presented image? Yikes!	How are you doing with your presented image? Can't answer
How are you doing in your professions?	How are you doing in your professions? Couldn't be better!	How are you doing in your professions? Doing well!	How are you doing in your professions? Neutral	How are you doing in your professions? Could be better.	How are you doing in your professions? Yikes!	How are you doing in your professions? Can't answer
How are you doing with your "daily rhythm"?	How are you doing with your "daily rhythm"? Couldn't be better!	How are you doing with your "daily rhythm"? Doing well!	How are you doing with your "daily rhythm"? Neutral	How are you doing with your "daily rhythm"? Could be better.	How are you doing with your "daily rhythm"? Yikes!	How are you doing with your "daily rhythm"? Can't answer
How are you doing with your income?	How are you doing with your income? Couldn't be better!	How are you doing with your income? Doing well!	How are you doing with your income? Neutral	How are you doing with your income? Could be better.	How are you doing with your income? Yikes!	How are you doing with your income? Can't answer
How are you doing planning for retirement?	How are you doing planning for retirement? Couldn't be better!	How are you doing planning for retirement? Doing well!	How are you doing planning for retirement? Neutral	How are you doing planning for retirement? Could be better.	How are you doing planning for retirement? Yikes!	How are you doing planning for retirement? Can't answer
How are you doing with recreation?	How are you doing with recreation? Couldn't be better!	How are you doing with recreation? Doing well!	How are you doing with recreation? Neutral	How are you doing with recreation? Could be better.	How are you doing with recreation? Yikes!	How are you doing with recreation? Can't answer
How are you doing with your passions and gifts?	How are you doing with your passions and gifts? Couldn't be better!	How are you doing with your passions and gifts? Doing well!	How are you doing with your passions and gifts? Neutral	How are you doing with your passions and gifts? Could be better.	How are you doing with your passions and gifts? Yikes!	How are you doing with your passions and gifts? Can't answer
How are you doing with "sacred rituals"?	How are you doing with "sacred rituals"? Couldn't be better!	How are you doing with "sacred rituals"? Doing well!	How are you doing with "sacred rituals"? Neutral	How are you doing with "sacred rituals"? Could be better.	How are you doing with "sacred rituals"? Yikes!	How are you doing with "sacred rituals"? Can't answer
How is your friendship circle?	How is your friendship circle? Couldn't be better!	How is your friendship circle? Doing well!	How is your friendship circle? Neutral	How is your friendship circle? Could be better.	How is your friendship circle? Yikes!	How is your friendship circle? Can't answer
How is your pace of gaining knowledge?	How is your pace of gaining knowledge? Couldn't be better!	How is your pace of gaining knowledge? Doing well!	How is your pace of gaining knowledge? Neutral	How is your pace of gaining knowledge? Could be better.	How is your pace of gaining knowledge? Yikes!	How is your pace of gaining knowledge? Can't answer
How are you doing taking care of you?	How are you doing taking care of you? Couldn't be better!	How are you doing taking care of you? Doing well!	How are you doing taking care of you? Neutral	How are you doing taking care of you? Could be better.	How are you doing taking care of you? Yikes!	How are you doing taking care of you? Can't answer
How are you doing with personal and professional accountability?	How are you doing with personal and professional accountability? Couldn't be better!	How are you doing with personal and professional accountability? Doing well!	How are you doing with personal and professional accountability? Neutral	How are you doing with personal and professional accountability? Could be better.	How are you doing with personal and professional accountability? Yikes!	How are you doing with personal and professional accountability? Can't answer

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* 10. Will you earn more than $650,000 this calendar year?

Yes

No (If there are special circumstances for lower income this year please let us know)

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* 11. Please upload your YTD P&L or YTD Paystub here

Regardless if you entered yes or no to question 10 please upload a PDF, DOC/X or JPG image

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 12. Will you fund more than 220 transactions this year?

Yes

No - let us know if you have lower volume due to higher loan amounts, reverse mortgages, you are an owner/partial non producer etc.

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* 13. Please upload your Closed Loan YTD Production Report here

Regardless if you answered yes or no to question 12 please upload a PDF, DOC/X or image version of your YTD Production Report

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 14. Will you work less than 40-hours a week, on average this year?

Yes

No (If there are special circumstances for increased hours please let us know)

We require each applicant to submit a 5 minute video on why you should be accepted into ELITE.

If you want to record or upload it right now please click this link:
We will also send you an email with instructions and a link to provide your video afterwards but all applicants must provide a video to be considered.