Starting Point

The purpose of this form is to guide you in getting a sense of where you are today. Please complete this form prior to your first coaching session. Please respond to the statements below to the best of your ability. If any of these are not clear or you would like to work on them in our coaching sessions, please indicate that.

Name

First Name

Last Name

Date

YYYY

What is your personal vision or what comes to mind when you think about this question?

Vision is the result you want to leave behind when all is said and done at the end of your life.

Purpose: What is your way of being/who do you want to be? What differences are you committed to make for yourself and others? What is truly most important for you?

If this is not clear for you, leave this blank for now or just list a few ideas.

What is your personal mission? How will you accomplish your purpose?

This is what you do/the roles you play to accomplish the purpose(s) above.

Current challenges: What are you dealing with right now that needs immediate attention or resolution?

Strengths: What do you see as your personal and professional strengths and qualities?

Blocks and barriers: What is it about you that stops you or makes it difficult for you to achieve or exceed your goals?

Regular self-care activities: What things do you do on a regular basis that keep you physically, mentally, emotionally, and spiritually well?

Personal values: What are some of your personal values? What’s important to you? Our personal values are the very essence of who we are.

Please list the three goals you would like to achieve within the next 90 days.

Please list some additional things you want me to know about you.