Program Goals Survey Form
Please complete this survey to share your program goals and planning needs. Your responses will help us tailor support and measure success.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Program Type
*
Please Select
Leadership Development
Technical Skills Training
Mentorship
Wellness Program
Other
What are your current goals for participating in this program?
*
Which outcome is your top priority?
*
Skill Improvement
Career Advancement
Networking
Personal Growth
Other
What is your preferred timeline for achieving your goals?
*
Please Select
Within 1 month
1–3 months
3–6 months
6–12 months
More than 1 year
What types of support would help you most?
*
One-on-one Coaching
Group Workshops
Online Resources
Peer Networking
Ongoing Feedback
Other
Please rate how confident you feel about reaching your program goals.
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
What barriers do you anticipate in reaching your goals?
Time Constraints
Resource Limitations
Lack of Motivation
Unclear Expectations
Other
How important are the following measures of success for you?
*
Rows
Not Important
Somewhat Important
Very Important
Achieving personal goals
1
2
3
Gaining new skills
4
5
6
Building professional network
7
8
9
Receiving recognition
10
11
12
Improving well-being
13
14
15
Please share any additional planning needs or comments.
Submit
Should be Empty: