Empowered Action Assessment

Get To Know You Survey

Please provide your full name and best phone number.

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* 1. Please provide your full name and best phone number.

Please provide your email address.

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* 2. Please provide your email address.

How fully are you living your dream/mission right now?

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* 3. How fully are you living your dream/mission right now?

I'm totally living my dream/mission ALL IN

I'm living my dream/mission half in

I'm barely living my dream/mission

I'm not living my dream/mission at all

What is the most significant challenge you are facing at this moment?

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* 4. What is the most significant challenge you are facing at this moment?

What are you doing to address this challenge?

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* 5. What are you doing to address this challenge?

How often do you get thrown off track?

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* 6. How often do you get thrown off track?

I never get thrown off track

I get thrown off track at least once a week

I get thrown off track at least once a month

I get thrown off track at least once a year

How long does it take you to recover from a setback?

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* 7. How long does it take you to recover from a setback?

I recover from setbacks within minutes

I recover from setbacks within hours

I recover from setbacks within days

I recover from setbacks within months

Are you ready to move outside your comfort zone for the sake of your mission? If so, why now?

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* 8. Are you ready to move outside your comfort zone for the sake of your mission? If so, why now?

On a scale of 1-10 (10=VERY ready), how ready are you to invest in living your dream ALL IN on a physical, spiritual, emotional and financial level?

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* 9. On a scale of 1-10 (10=VERY ready), how ready are you to invest in living your dream ALL IN on a physical, spiritual, emotional and financial level?

What personal or spiritual development have you invested money into before and what have the results been?

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* 1. Please provide your full name and best phone number.

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* 2. Please provide your email address.

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* 3. How fully are you living your dream/mission right now?

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* 4. What is the most significant challenge you are facing at this moment?

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* 5. What are you doing to address this challenge?

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* 6. How often do you get thrown off track?

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* 7. How long does it take you to recover from a setback?

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* 8. Are you ready to move outside your comfort zone for the sake of your mission? If so, why now?

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* 9. On a scale of 1-10 (10=VERY ready), how ready are you to invest in living your dream ALL IN on a physical, spiritual, emotional and financial level?

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* 10. What personal or spiritual development have you invested money into before and what have the results been?