Please complete the following member assessment to empower the most productive coaching program. All identifiable information will be kept confidential.

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* 1. Personal Information:

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* 2. Program of Interest

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* 3. What best describes your primary job function?

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* 4. How many months have you worked for your current organization?

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* 5. How many months have you been in your current position at work?

What best describes the last 6 months in your work/life?

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* 6. Transitioned to a new company and/or a new role.

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* 7. Helped manage a significant change initiative at my organization.

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* 8. Been working toward a career or role change.

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* 9. Experienced a significant increase in my level of responsibility at work.

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* 10. Responsibilities that are new, different, and/or unfamiliar.

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Never 		2 3 4 5
Always
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* 11. A high level of pressure

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Never 		2 3 4 5
Always
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* 12. What would you value most from coaching right now?

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* 13. If you had an additional hour every week to dedicate toward professional or personal development, what would you rather invest it in:

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* 14. Do you have a general goal that you would like to work toward?

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* 15. Which of the following best describes the primary goals/topics you want to work on?Choose all skills that support this goal:

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* 16. It is important to me to make significant progress on this goal:

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* 17. How confident are you that you can make significant progress on this goal/topic?

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Not confident 		5
Highly Confident
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* 18. I want to spend a lot more time on my professional and personal development.

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Strongly disagree 		5
Strongly agree
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* 19. When do you plan to start actively working with a coach?

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* 20. Ideally, how often would you like to meet with a coach?

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* 21. If you are experiencing more change than usual, please use a few words to describe the changes you are experiencing. (Optional)

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* 22. Have you received professional coaching prior to Inspiring Excellence coaching?

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* 23. When engaging with a coach I prefer a style that offers:

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* 24. When working towards goals, I prefer a style that is:

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* 25. Right now is a good time for me to begin working with a coach.

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Mostly disagree 		2 3 4 5
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* 26. I have a clear understanding of what I would like to work on with my coach.

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Mostly disagree 		2 3 4 5
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* 27. I am open to investing in my personal development right now.

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Mostly disagree 		2 3 4 5
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* 28. I believe I can achieve meaningful change or growth by working with a coach.

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Mostly disagree 		2 3 4 5
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* 29. What do you want to gain from coaching?

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* 30. With 0 as no progress toward this goal(s) and 10 as achieving this goal(s), where do you stand today?

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No progress toward this goal(s) 		2 3 4 5 6 7 8 9 10
Achieving this goal(s)
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* 31. What is your approximate annual income before tax? (This helps us tailor recommendations and options for you.)

Thanks for investing in you!

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