Unconquerable Platinum Coaching Questionnaire
Unconquerable Platinum Coaching Questionnaire THIS QUESTIONNAIRE IS CONFIDENTIAL AND WILL ONLY BE REVIEWED BY YOU AND YOUR COACH Please enter the following information: Full Name: Email: Address (Street, City, State, Zip): Home Phone: Office Phone: Cell Phone: Website(s): Birthday: Marital Status: Emergency Contact Name: Emergency Contact Phone: Month Entering Unconquerable Platinum (this month/year):
Starter Statements: COACHING
Your Responses Please enter your answers in the boxes below
The thing that motivated me the most to join the Unconquerable Platinum coaching program at this time in my life is… The reason I am absolutely committed to succeeding in this program – and in my life – right now is…
If I had to focus on just two things with Gary, they’d include…
If I could have any project “done for me” that project would be…
The number one thing that is pushing me to make a change in my life or business right now is… The thing(s) that give me energy to make this change is/are…
Page 1 of 9
Starter Statements: MY LIFE On a scale of 1-10, I would rate the following
Your Responses Please type your answers in the boxes below.
[Rate each 1-10, with 10 being the highest] How closely I am living in harmony with my core values and priorities: How positively I look at life in general: The depth of my self-awareness: Level of comfort with who I am: The support I get from others in my life: The support I give to other in my life: I get the amount of exercise I should: The health and balance of my diet: The adequacy of stress-release activities in my life: My ability to simply accept the challenges in my life: My ability to proactively address problems:
The Values that guide me in my life are…
The five most important things in my life right now are…
Compass
My greatest purpose in life right now is…
The thing I need to work the most on in my life right now is…
The dream that I absolutely must start moving toward once again is… The main goal I’m going to focus on in the next three months to improve my life is… The reason I must achieve this goal is…
Page 2 of 9
The five bold steps I’m going to take to achieve this goal are…
The times when I feel like there is a greater power in this world than myself are…
The emotions I felt on a consistent basis over the past six months could be described as… The emotions that have prevented me from moving forward as fast as I know I can are… The way I really feel about what I’m doing in life right now is…
Outlook
Three reasons I should be hopeful about the future are…
My ideal life is worth fighting for because…
The last time I truly laughed was…
Other people would characterize my outlook on life as…
The last time I thought "outside the box" to solve a challenge was…
My "outside the box" solution was…
Page 3 of 9
The thing I’m really proud about in my life right now is…
When I hear a disempowering voice in my head, it’s usually telling me that… The real reason I’m doing what I’m doing for a career right now is… If I continue doing what I’m doing, five years from now I’ll feel…
Identity
I feel most in control of myself and my destiny when…
I feel least in control of myself when…
A recent experience I had when I felt completely authentic, completely me, was when… In the past, the parts of me that I sacrificed or hid or buried in order to please other people were… One area of my life where I’m consistently adapting and acting like someone else seems to be when… If I didn’t care so much what other people thought, the first thing I’d probably do is… If I started believing a little more in myself, I’d be much likelier to…
Page 4 of 9
I know I’m a worthy and capable person because…
I know I’m much more courageous than I give myself credit for, because …
If I am being totally honest, the reason enough people don’t know what I really want and need is because… The people in my life who are treating me poorly right now are… I’ve allowed these people to treat me this way by…
Connection
I know that the people in my life want me to be happy, because…
The relationships in my life that are truly supporting my well-being and growth are the ones I have with… A person who was a real miracle worker in my life was…
The person in my life who could use a miracle right about now is…
The three reasons I most appreciate my current or last significant other are that he or she… I would describe my ideal relationship as one that…
Page 5 of 9
When I feel attacked my first reaction is to…
When I am in the middle of a personal conflict, my body generally physically reacts in this way… My greatest fear about my personal relationships is…
The things that trigger me to respond with anger are…
The things that trigger me to close up emotionally are…
Health
The biggest challenges to taking care of my physical health are…
Things I've done to take care of my physical health in the past 6 months, that have been beneficial, are Things I've done to take care of my physical health in the past 6 months, that have not been helpful, are… My diet is or is not beneficial to my general health because…
The amount of sleep I get each night is…
The amount of "down time" I get each week is…
Page 6 of 9
The times of day when I feel the most physically energized are…
The times of day when I feel the most mentally energized are…
The things I do that help me feel physically energized include…
The things I do that help me feel mentally energized include…
The main reason I am where I am in life right now is because I chose to…
The main areas of my life where I seem to be succeeding are…
Proaction
The main areas of my life where I seem to be spinning my wheels are…
If I am being honest, the reason I don’t have exactly what I’ve always wanted in life right now is because… If I am being totally honest, I’ve held back a few times in my life because…
I always wish I had more time to spend doing things like…
The work or hobbies that completely absorb my attention when I’m doing them is…
Page 7 of 9
In order to be the person I know I’m capable of being, I’d have to start behaving more like…
The biggest challenge in my life right now is…
Starter Statements: MY BUSINESS If I could do anything in the world, and KNOW that I could make an awesome living while doing what I love, I would…
Your Responses Please type your answers in the boxes below.
For the last three years, my business has been mostly focused on… If I maintain the same course I’m on now financially (previous to this coaching program), in five years I will... My greatest fear about my business is…
A problem or fear that I’ve been backing down from in my business lately is…
The thing I must do right now in order to step up to this problem or fear is…
When I see a conflict situation at work my first reaction is to…
Page 8 of 9
The formal process I have in place for dealing with conflict in my business are…
The informal processes I have for dealing with conflict in my business are…
My areas of expertise that are real strengths include…
Right now, each month I’m earning approximately…
The best things I’ve found to keep myself motivated with my business include…
If I could name five qualities that make a person successful in business, they would be… I’ll know I’ve succeeded in my business when…
In ten years, I’d like to be in a financial place where I can…
At the end of my life, I want to look back at my business life and know that I…
When I succeed at the level I really want to, the way I’d like to celebrate is to… Congratulations! Thanks for completing this Questionnaire! You stepped up, and now your journey has begun!
Page 9 of 9
Starter Statements: COACHING
Your Responses Please enter your answers in the boxes below
The thing that motivated me the most to join the Unconquerable Platinum coaching program at this time in my life is… The reason I am absolutely committed to succeeding in this program – and in my life – right now is…
If I had to focus on just two things with Gary, they’d include…
If I could have any project “done for me” that project would be…
The number one thing that is pushing me to make a change in my life or business right now is… The thing(s) that give me energy to make this change is/are…
Page 1 of 9
Starter Statements: MY LIFE On a scale of 1-10, I would rate the following
Your Responses Please type your answers in the boxes below.
[Rate each 1-10, with 10 being the highest] How closely I am living in harmony with my core values and priorities: How positively I look at life in general: The depth of my self-awareness: Level of comfort with who I am: The support I get from others in my life: The support I give to other in my life: I get the amount of exercise I should: The health and balance of my diet: The adequacy of stress-release activities in my life: My ability to simply accept the challenges in my life: My ability to proactively address problems:
The Values that guide me in my life are…
The five most important things in my life right now are…
Compass
My greatest purpose in life right now is…
The thing I need to work the most on in my life right now is…
The dream that I absolutely must start moving toward once again is… The main goal I’m going to focus on in the next three months to improve my life is… The reason I must achieve this goal is…
Page 2 of 9
The five bold steps I’m going to take to achieve this goal are…
The times when I feel like there is a greater power in this world than myself are…
The emotions I felt on a consistent basis over the past six months could be described as… The emotions that have prevented me from moving forward as fast as I know I can are… The way I really feel about what I’m doing in life right now is…
Outlook
Three reasons I should be hopeful about the future are…
My ideal life is worth fighting for because…
The last time I truly laughed was…
Other people would characterize my outlook on life as…
The last time I thought "outside the box" to solve a challenge was…
My "outside the box" solution was…
Page 3 of 9
The thing I’m really proud about in my life right now is…
When I hear a disempowering voice in my head, it’s usually telling me that… The real reason I’m doing what I’m doing for a career right now is… If I continue doing what I’m doing, five years from now I’ll feel…
Identity
I feel most in control of myself and my destiny when…
I feel least in control of myself when…
A recent experience I had when I felt completely authentic, completely me, was when… In the past, the parts of me that I sacrificed or hid or buried in order to please other people were… One area of my life where I’m consistently adapting and acting like someone else seems to be when… If I didn’t care so much what other people thought, the first thing I’d probably do is… If I started believing a little more in myself, I’d be much likelier to…
Page 4 of 9
I know I’m a worthy and capable person because…
I know I’m much more courageous than I give myself credit for, because …
If I am being totally honest, the reason enough people don’t know what I really want and need is because… The people in my life who are treating me poorly right now are… I’ve allowed these people to treat me this way by…
Connection
I know that the people in my life want me to be happy, because…
The relationships in my life that are truly supporting my well-being and growth are the ones I have with… A person who was a real miracle worker in my life was…
The person in my life who could use a miracle right about now is…
The three reasons I most appreciate my current or last significant other are that he or she… I would describe my ideal relationship as one that…
Page 5 of 9
When I feel attacked my first reaction is to…
When I am in the middle of a personal conflict, my body generally physically reacts in this way… My greatest fear about my personal relationships is…
The things that trigger me to respond with anger are…
The things that trigger me to close up emotionally are…
Health
The biggest challenges to taking care of my physical health are…
Things I've done to take care of my physical health in the past 6 months, that have been beneficial, are Things I've done to take care of my physical health in the past 6 months, that have not been helpful, are… My diet is or is not beneficial to my general health because…
The amount of sleep I get each night is…
The amount of "down time" I get each week is…
Page 6 of 9
The times of day when I feel the most physically energized are…
The times of day when I feel the most mentally energized are…
The things I do that help me feel physically energized include…
The things I do that help me feel mentally energized include…
The main reason I am where I am in life right now is because I chose to…
The main areas of my life where I seem to be succeeding are…
Proaction
The main areas of my life where I seem to be spinning my wheels are…
If I am being honest, the reason I don’t have exactly what I’ve always wanted in life right now is because… If I am being totally honest, I’ve held back a few times in my life because…
I always wish I had more time to spend doing things like…
The work or hobbies that completely absorb my attention when I’m doing them is…
Page 7 of 9
In order to be the person I know I’m capable of being, I’d have to start behaving more like…
The biggest challenge in my life right now is…
Starter Statements: MY BUSINESS If I could do anything in the world, and KNOW that I could make an awesome living while doing what I love, I would…
Your Responses Please type your answers in the boxes below.
For the last three years, my business has been mostly focused on… If I maintain the same course I’m on now financially (previous to this coaching program), in five years I will... My greatest fear about my business is…
A problem or fear that I’ve been backing down from in my business lately is…
The thing I must do right now in order to step up to this problem or fear is…
When I see a conflict situation at work my first reaction is to…
Page 8 of 9
The formal process I have in place for dealing with conflict in my business are…
The informal processes I have for dealing with conflict in my business are…
My areas of expertise that are real strengths include…
Right now, each month I’m earning approximately…
The best things I’ve found to keep myself motivated with my business include…
If I could name five qualities that make a person successful in business, they would be… I’ll know I’ve succeeded in my business when…
In ten years, I’d like to be in a financial place where I can…
At the end of my life, I want to look back at my business life and know that I…
When I succeed at the level I really want to, the way I’d like to celebrate is to… Congratulations! Thanks for completing this Questionnaire! You stepped up, and now your journey has begun!
Page 9 of 9
