VIP (Vision, Inspiration & Preparation) Life Mentoring Program

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* 1. How would you rate the current state of your life overall?

	Very Satisfying	Satisfying	Neutral	Unsatisfying	Extremely Unsatisfying	N/A
Scale	Scale Very Satisfying	Scale Satisfying	Scale Neutral	Scale Unsatisfying	Scale Extremely Unsatisfying	Scale N/A

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* 2. Have you taken steps to change the current state of your life?

	Yes	Yes, but not consistently	Neutral	I want to but I don't know where to	No	N/A
Scale	Scale Yes	Scale Yes, but not consistently	Scale Neutral	Scale I want to but I don't know where to	Scale No	Scale N/A

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* 3. If you answered yes or yes, but not consistently please elaborate.

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* 4. How many areas of your life do you feel you need to see movement?

	One area	Two areas	Three areas	Four areas	Five or more areas	N/A
Scale	Scale One area	Scale Two areas	Scale Three areas	Scale Four areas	Scale Five or more areas	Scale N/A

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* 5. How motivated are you to make a change in your life?

	I'm extremely motivated	I'm motivated	Neutral	I'm inconsistently motivated	I'm unmotivated	N/A
Scale	Scale I'm extremely motivated	Scale I'm motivated	Scale Neutral	Scale I'm inconsistently motivated	Scale I'm unmotivated	Scale N/A

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* 6. How much do you believe that you can achieve the change you wish see?

	I believe!	I know I can do it but I'm scared.	Neutral	I'm skeptical.	I feel hopeless.	N/A
Scale	Scale I believe!	Scale I know I can do it but I'm scared.	Scale Neutral	Scale I'm skeptical.	Scale I feel hopeless.	Scale N/A

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* 7. How much time do you have to invest every week for this program?

	7 hours a week.	6 hours a week.	I'm unsure	5 hours a week.	4 or less hours a week	N/A
Scale	Scale 7 hours a week.	Scale 6 hours a week.	Scale I'm unsure	Scale 5 hours a week.	Scale 4 or less hours a week	Scale N/A

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* 8. How frequently do you receive spa treatments such as massages, facials, body wraps? Spa treatments are not hair and nails/pedicures.

	Weekly	Bi-weekly	Monthly	I don't get spa treatments but I get my hair and nails/pedicure	Less than every 3 months	N/A, I have never received a spa treatment
Scale	Scale Weekly	Scale Bi-weekly	Scale Monthly	Scale I don't get spa treatments but I get my hair and nails/pedicure	Scale Less than every 3 months	Scale N/A, I have never received a spa treatment

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* 9. How frequently do you practice yoga?

	Weekly	Bi-weekly	Monthly	I don't practice yoga but I workout/gym/walk	It's been over 6 months	N/A, I have never practice yoga or it's been over a year
Scale	Scale Weekly	Scale Bi-weekly	Scale Monthly	Scale I don't practice yoga but I workout/gym/walk	Scale It's been over 6 months	Scale N/A, I have never practice yoga or it's been over a year

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* 10. Do you like to read?

	I love to read!	I don't mind reading	Neutral	I don't like to read, but I will.	I don't like read.	N/A
Scale	Scale I love to read!	Scale I don't mind reading	Scale Neutral	Scale I don't like to read, but I will.	Scale I don't like read.	Scale N/A

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* 11. Do you have a faith, pray or meditate?

	Yes, I faithfully practice a religion	Yes, I have a faith	Yes, I am spiritual. I pray and meditate regularly.	It's complicated	I'm an atheist.	N/A
Scale	Scale Yes, I faithfully practice a religion	Scale Yes, I have a faith	Scale Yes, I am spiritual. I pray and meditate regularly.	Scale It's complicated	Scale I'm an atheist.	Scale N/A

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* 12. Do you have school age children?

	No. I do not have any children or I have an adult child/children	Yes, I have one school age child.	Yes, I have two school age children.	Yes, I have 3 school age children.	Yes, I have 4 or more school age children.	N/A
Scale	Scale No. I do not have any children or I have an adult child/children	Scale Yes, I have one school age child.	Scale Yes, I have two school age children.	Scale Yes, I have 3 school age children.	Scale Yes, I have 4 or more school age children.	Scale N/A

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* 13. Do you have a supportive partner or a support system (friends, parents, in-laws, etc)

	I have a supportive partner and a strong support system.	I have a supportive partner or a strong support system.	I have a partner and/or support system. I am not sure how supportive they may be.	I know my partner and/or support system will not be supportive.	I do not have a partner or a support system	N/A
Scale	Scale I have a supportive partner and a strong support system.	Scale I have a supportive partner or a strong support system.	Scale I have a partner and/or support system. I am not sure how supportive they may be.	Scale I know my partner and/or support system will not be supportive.	Scale I do not have a partner or a support system	Scale N/A

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* 14. How much are you willing to invest to change your life/situation?

	I am willing to invest whatever dollar amount it takes.	I am willing to invest.	I have a set budget.	I don't have a lot to invest but I need a change.	I don't have anything to invest.	N/A
Scale	Scale I am willing to invest whatever dollar amount it takes.	Scale I am willing to invest.	Scale I have a set budget.	Scale I don't have a lot to invest but I need a change.	Scale I don't have anything to invest.	Scale N/A