Self Assessment Tool Form

Your Name:

Email Address:

How did you hear about us?

Is this an individual assessment or business?

What needs to BE DIFFERENT right now? Please state in less than 10 words

Have you made clear decisions to what needs to BE DIFFERENT yet?

Have you engaged in any other help to BE DIFFERENT yet?

Do you have clear goals to BE DIFFERENT?

Have you completed any research or analysis to support what needs to BE DIFFERENT?

Please describe in 20 words or less your biggest achievement so far personally or for your business:

Now, please describe in 20 words or less what brings you the most satisfaction personally or for your business:

Using no more than 10 words please state what annoys, irritates or worries you the most currently about you personally or your business:

If you had to choose only 5 key words to describe YOU, which would you choose?

Now please choose only 5 key words to describe how ‘others’ would describe YOU.

Using 20 words or less; please state if you could change just ONE thing, what would it be?

What things do you feel you need to develop to improve YOU? (Please list all things; if you wish please state the level where you feel you’re at now).

Using 20 words or less; please describe what you fear most:

Please use just one word to summarise your greatest moment EVER!:

I have clear objectives:

My objectives are realistic:

My objectives are achievable in the time set:

Things are often out of my control:

There hasn't been much luck lately:

Other's don't take me seriously:

I often sabotage my own success:

I am extremely confident:

I take proactive steps to get what I want:

I often lack motivation to acheive what I want:

I am passionate about lmy goals:

I am an impatient person:

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Self Assessment Tool

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