“The Empowered”

Name *

First Name

Last Name

Energized Q1 | How often do you feel energized when working toward your goals? *

Rarely

Occasionally

Sometimes

Often

Always

Energized Q2 | When you think about your goals, how do you feel? *

Uncertain, and drained

Interested, but lacking energy

Motivated, but not fully energized

Energized & Passionate

Motivated Q1 | How often do you take intentional action toward your personal or professional goals? *

Rarely

Occasionally

Sometimes

Often

Always

Motivated Q2 | How do you stay motivated to continue making progress toward your goals, even when challenges arise? *

I struggle to stay motivated

I rely heavily on external encouragement

I try, but often lose momentum

I stay focused and adapt to challenges

I stay motivated and adapt with confidence

Patient Q1 | How comfortable are you with not seeing immediate results in your personal or professional growth? *

Very uncomfortable

Somewhat uncomfortable

Neutral

Comfortable

Very comfortable

Patient Q2 | When progress is slow, how do you typically respond? *

I lose motivation and consider giving up

I feel discouraged but keep going

I stay neutral and wait for things to change

I remind myself that growth takes time

I trust that slow progress is still progress and keep moving forward

Optimistic Q1 | How often do you focus on the positive aspects of a situation, even when things don’t go as planned? *

Rarely

Occasionally

Sometimes

Often

Always

Optimistic Q2 | How open are you to exploring new opportunities, even if they involve taking risks? *

Not open at all

Slightly open

Neutral

Open

Very open and excited to explore new opportunities

Willing Q1 | How often do you push past mental barriers or self-doubt in order to move forward? *

Rarely

Occasionally

Sometimes

Often

Always

Willing Q2 | How willing are you to step outside your comfort zone in order to grow personally or professionally? *

Not willing at all

Slightly willing

Neutral

Willing

Very willing and eager to push myself

Engaged Q1 | How often do you actively engage in activities or practices that contribute to your personal or professional growth? *

Rarely

Occasionally

Sometimes

Often

Always

Engaged Q2 | When working toward your goals, how present do you feel in the moment, without distractions? *

Very distracted, not focused

Sometimes distracted

Neutral

Mostly present with occasional distractions

Always fully present and focused

Resilient Q1 | When things don’t go as planned, how quickly do you bounce back and adjust your approach? *

Very slowly

Slowly

Neutral

Quickly

Very quickly and proactively adjust my approach

Resilient Q2 | How do you typically respond when you face a major setback or failure in your journey toward a goal? *

I feel defeated and struggle to move forward

I feel discouraged but try to keep going

I remain neutral and reflect on the situation

I push through and keep working despite the setback

I adapt quickly and see the setback as a learning opportunity