EmpowHer Assessment Form

As your mentor, it is helpful for me to find out more about you so that I can better support, encourage, and challenge you as you move toward your ideal life.

Please take some time to enjoy the reflection process that follows. Enter your responses into the form below and click submit. If you have any questions, email me at [email protected].

Name

Phone

What have been your three most fulfilling accomplishments in life, thus far

What was the biggest thing you have had to overcome?

How strong/powerful/healthy have your past personal or business role models been?

How have you failed, and how has that affected the way you think and act today?

Have you worked with a coach before? What worked? What did not work

How have your attitudes about people and life changed over the past 5 years?

What has made you feel the most successful or powerful?

Do you have any mental health challenges such as depression, bipolar disorder, anxiety or other challenges that have affected you? Tell me about that.

What should I know about your professional background or history?

What should I know about your personal background or family history?

What are the three biggest changes you want to make in your life in the next 3 months?

What are the three biggest changes you want to make in your life over the next 3 years?

What do you most want to achieve during our initial coaching period? What most threatens to hold you back from achieving this desire?

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EmpowHer Assessment Form

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