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Self Evaluation for PB Mentors

Self Evaluation for PB Mentors

Self Evaluation Form

Fields marked * are mandatory.

Q/A
Personal details
Finish

Required Information:

Step 1/3

1. Do you find it challenging or easy to define what you want in life personally and professionally? *
Easy
Difficult (Select which one applies)

2. On a scale of 1-10 (10 being the highest) as you define it today, have you been successful in life? *
(Select which one applies)

3. Day to day, what is the greatest challenge you face in getting what you would like out of life? *

(Check all that apply!)

4. How do you Define Success for yourself? *

(Check all that apply!)

5. In seeking out someone to assist you with all of this and more, what are the most important things you wish to accomplish after reaching out today? *

(Check all that apply!)

Personal Information:

Step 2/3

First Name:*

Last Name:*

Email:*

Contact Number:*

Additional Comments:(if any)

*Verification:

Staying Positive
Being Consistent
Having a Plan
Lack of Confidence
Lack of Knowledge
Others perception of you
Other- Please describe

Money
Fame
Ego
Title
Purpose
Proving someone wrong or yourself right
Pleasing someone else
Providing
Other- Please Describe

Overall Guidance
A Confidence Boost
More Knowledge in Business, Life In General, Becoming a Better Leader, Coach or Player
Removing Self Limiting Beliefs or Barriers to Success
Getting A Promotion
Changing Careers
Re-imagining/Reinventing yourself
Getting over the Hump, so you can Earn more Money
Deciding on whether you should become an Entrepreneur
Other, please be Specific