High Performance Self-Assessment

Getting to Know You

Goal: To help you reach heightened levels of clarity, energy, courage, productivity, and influence on your march to a successful, healthy, and fully charged life.

Instructions:
Please answer the questions below and on the following pages to the best of your ability and email or fax your responses to me before our call.

Question Title

* 1. General Information

Your Full Name

City/Town

State/Province

Country

Email Address

Question Title

* 2. Which of the following best describes your current occupation?

Healthcare Practitioners and Technical Occupations

Office and Administrative Support Occupations

Business and Financial Operations Occupations

Farming, Fishing, and Forestry Occupations

Community and Social Service Occupations

Personal Care and Service Occupations

Healthcare Support Occupations

Construction and Extraction Occupations

Protective Service Occupations

Installation, Maintenance, and Repair Occupations

Production Occupations

Architecture and Engineering Occupations

Management Occupations

Building and Grounds Cleaning and Maintenance Occupations

Sales and Related Occupations

Legal Occupations

Arts, Design, Entertainment, Sports, and Media Occupations

Life, Physical, and Social Science Occupations

Food Preparation and Serving Related Occupations

Computer and Mathematical Occupations

Education, Training, and Library Occupations

Transportation and Materials Moving Occupations

Other (please specify)

Question Title

* 3. Are you male or female?

Male

Female

Question Title

* 4. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single

Question Title

* 5. Please briefly describe how you heard about my coaching services and why you would like a Strategy Session with me:

Source: This tool is based on proprietary concepts from High Performance Institute's Certified High Performance Coach ProgramTM. Do not duplicate or distribute without permission.