Power Up Blueprint Questionnaire Question Title * 1. First Name: Question Title * 2. Last Name Question Title * 3. Email Question Title * 4. Phone Number Question Title * 5. Current Role / Title CEO, President and/or Business Owner Executive-level Role (e.g., COO, VP, SVP, EVP) Senior Leadership Role (e.g., Director, Manager) Self-Employed / Sole Practitioner (e.g., Coach, Consultant, Therapist, Counsellor) Board Member Question Title * 6. Name of Organization (optional) Question Title * 7. Number of Direct Reports 0 1 - 3 3 - 7 >7 Question Title * 8. What is your vision for yourself as a leader or entrepreneur? What do you most want to achieve for yourself? Check all that apply. Continue to progress to more complex and challenging leadership roles Grow my business without getting bogged down or undermined by people related challenges Own my success, lead with confidence and not feel like an imposter Stop sacrificing myself, working harder than others and constantly trying to prove myself Realize my potential which I don't feel like I am right now as there is more that I am capable of Increase my impact on my organization, drive change in my industry and achieve greater mastery All of the above Other (please specify) Question Title * 9. What is your biggest challenge or barrier as a female leader or entrepreneur when asserting your authority, leading powerfully and pursuing your full potential? Question Title * 10. Be 100% Honest - what do you think is stopping you from leading authentically? Question Title * 11. What actions have you take in the past to support your development? Check all that apply. Reading Books, Listening to Podcasts, etc On-the-Job Training and Mentoring Company Sponsored Leadership Training Company Sponsored Leadership Coaching (individual) Therapy / Personal Counselling Personal or Leadership Coaching (self-paid) Participating in Learning through Professional Associations None of the Above Other (please specify) Question Title * 12. What would be the most important criteria for your success if we work together? Be supportive, nurturing in approach; empathetic Give me direct approaches and solutions to fixing my challenges (tell me what to do) Hold me accountable for following through so I invest in myself Access to coaching and resources that fit my schedule Timely responses to my challenges and questions Being part of a community of like-women leaders and entrepreneurs Question Title * 13. How ready are you to take action in developing your leadership authority and achieving your leadership potential? Past Ready Definitely Ready Probably Ready Still Researching / Considering Unsure If Ready Question Title * 14. Do you have the finances or financial support of your organization to invest in your development? Yes No Potentially - approval required Question Title * 15. Please enter your Facebook Profile URL so we can connect :-) Done
