First Name
Last Name
Email
Since 102, what positive changes have happened in your life?
Since 102, what are you still struggling with?
What is prompting you to take this class? What is happening or NOT happening in your life that you want to see?
What 101 tools do you use and which ones do you need to implement more of?
What did you enjoy about 101 and 102 that you hope to get in 103?
To who or what do you turn to when you are struggling or need guidance and support?
What does an average day look like for you?
Who or what is your Higher Power (Director) and how do you communicate or nurture this connection on a daily basis? How do you want to improve this connection?
Are you nourishing your body with healthy food and drink? If not, what is stopping you from doing this?
What unhealthy things are you putting in your body?
Do you move your body regularly and if not, what is keeping you from doing that?
How are you nurturing healthy relationships and what relationships still cause problems for you and why?
What are your passions and how are you nurturing them currently? If you aren't, what is stopping you?
How do you honor your inner star with play and fun on a daily basis? If you don't, what is keeping you from this?
What jobs or careers have you considered when it comes to following your life purpose? Have you looked into these options?
What do you believe your life mission is and how do you currently practice this?
What do you hope to get out of this class?
What is getting in the way of you doing what you want to do? (Hold SHIFT key to select multiple)
Select...
Fear of being visible
I don't know what I want to do
I don't have the skills to be successful
I am not good enough
I need more education or experience
I don't have time to pursue what I want
I don't have money
I won't make money
How can I sustain this if I pursue?
Fear of judgment
Guilt (I have kids, family)
I can't do it alone
I don't know where to start
Too many other obligations or things to do
Other
What symptoms do you experience when you are operating from fear? (Hold SHIFT key to select multiple)
Select...
Procrastination
Isolation or avoidance
Drink alcohol
Smoke or other drugs
Binge eat or don't eat
Gain or lose weight
Caffeine and/or sugar
Recycle the past
Create drama
Self-sabotage
Take it out on others
Try to change others (Out of my business)
Make impulsive decisions
Shop
Exercise obsessively
Think negatively
Worry about what others think
Suffer sleep & health problems
Think or act irrationally
What have the consequences been when you do not follow your passions and purpose?
How ready are you to commit and make a change?
Select...
0 - I want to stay stuck & miserable
1
2
3 - I am somewhat ready
4
5
6 - I am stoked and ready!
If you answered somewhat ready or that you wanted to stay stuck, what is more important in your life right now than living your life and following your purpose?
Who in your life is supporting you right now?
If you do not have support, how would having support change things for you?
If you could wake up tomorrow and didn't have to worry about time, money, fear, or anyone else...what would you be doing?
After taking this assessment, what is one thing you will start changing right now?
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