Coaching Assessment Questionnaire

Name:
Phone Number:
E-mail address:
Birthday:
Address:
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FAITH
Tell us a little about your faith and belief:
GOALS
List three goals you want to achieve over the next three months:
List the three biggest changes you want to make in your life over the next year:
PERSONAL HISTORY
List the three greatest accomplishments in your life to date:
What is the hardest thing you have ever had to overcome:
Who are or have been your major role models:
What major transitions have you had in the past two years? (entering or approaching a new decade of life, a new relationship, a new job, a new role, a new residence, changes in children's ages/stages of life, separation, divorce, death of a loved one, birth of a child, marriage, etc.)
YOUR LIFE
Who are the key people in your life and what do they provide for you:
Is your life one of your choosing? If not, which parts are being chosen for you:
On a scale of 1 - 10, 10 = HIGH, provide a number that represents your current level/degree of stress:
What are your primary stressors:
List five (5) things that you are tolerating or putting up with in your life at present.
(information you cannot find, rude people, poor lighting, tight shoes, dented car, job dissatisfaction, dead plants, broken equipment, old appliances, etc.)
COACHING YOU
What would you expect or like your Coach to do if you get behind on your goals:
How will you know when you are receiving value (i.e. - your money's worth) from the Coaching process:
What types of approaches discourage you or take away your motivation:
How can your Coach best support you in the Coaching relationship?
Using each number once, place the following in order of importance. Rank using 1-10 (1= Most Important; 10 = Least Important)
Brainstorming Strategies Together:
Insight into Who You Are and Your Potential:
Support, Encouragement, Validation:
Exploring and Removing Blocks and Obstacles to Your Success:
Accountability; Checking up on Goals:
Working through Self-Improvement Programs Together:
Suggesting or Designing Action Steps:
Painting a Vision of What You Can Become or Accomplish:
Strategic Planning:
Directness: Asking Hard Questions; Challenging You to Move Forward:
POTENTIAL & POSSIBILITY
Do you have a personal or professional vision?
If yes, what is it:
What would you like to contribute to the world:
What is a dream or goal you have given up on:
What part of yourself, if any, have you given up on:
On a scale of 1 to 10 (10= HIGH), rate the quality of your life today:
What Events, Seminars have you attended or books have you read which have had the most impact on you:

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