Discovery Survey for Assessments

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Contact Info:

Name*

Company*

Date*

Cell Phone Number*

Secondary Phone Number

Primary Email*

Secondary Email

DOB*

Mailing Address:*

1 - What is your relationship with Feedback?

Review the options below with honesty and select which TWO most resonate with you.

1. What is your relationship with Feedback?*

a. Accept feedback from trusted people or experts.

b. Reject feedback.

c. Seek out feedback for growth.

d. Accept feedback on behavior (usually in private).

e. Open to and ask for feedback from anyone.

2 - Have you been through any assessments before? Either a self-assessment or a 360?

(As a definition, a 360 instrument includes several raters from multiple dimensions of our life that rate you. A Self Assessment survey is a tool used to rate yourself against a set of types or typologies).

1. Have you been through any assessments before? Either a self-assessment or a 360?*

3 - What is your intention or expectations in taking an assessment?

1. What is your intention or expectations in taking an assessment?*

4 - What is the context of your professional role? (Expand on any of these areas below. If not applicable, state N/A).

New or confusing Leadership Responsibilities? (To become more in my role)*

New or confusing Leadership Accountabilities? (Others expect more from my role)*

Direct Reports?*

Upload a copy of your current organizational chart.

Max. file size: 256 MB.

Current or emerging Team Structure?*

How long have you worked in the organization and in this role?*

The experience of education, training?*

5 - What are your leadership challenges?

a. Define Challenges: Reflect on any experiences you’ve had managing or leading, or in being managed or led. Identify any obstacles or challenges you’ve discovered about your own leadership. Briefly, list two such challenges you would like to address. Please be specific. For instance, instead of just mentioning communication, think about it: what about communication, specifically, challenges you: Expressing yourself, listening, sharing ideas, articulating your vision, making yourself understood, etc.?

Define Challenges*

b. Distinguish Challenges: Please share a recent, specific example to distinguish each of these two challenges (from a. above)

Distinguish Challenges*

6 - Have you experienced any leadership development before? worked with a coach before?

6. Have you experienced any leadership development before? worked with a coach before?*

7 - What are your developmental goals? (Please be specific and include timelines)

7. What are your developmental goals? (Please be specific and include timelines)*

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