Self Assessment Form Self Assessment Form Do you feel like your life is in a maze, bumping into walls? Or, is your life on the straight road to success? Self Assessment Consider the areas noted below. Where are you in your life today? Use the following measurement system: 1 = I REALLY need help in this area. 5 = I'm doing okay in this area. Your Life Today Rate Your Self Confidence in Your Personal / Professional Life. * 1 2 3 4 5 Rate Your Ability to Effectively Communicate with Others * 1 2 3 4 5 Your Ability to Manage Stress. * 1 2 3 4 5 Rate Your Work / Personal Life Balance. * 1 2 3 4 5 Rate Your Ability to Feel "Meaning" in Your Life Given Work and Personal Needs. * 1 2 3 4 5 How Well Do You Set Goals in Your Life? . * 1 2 3 4 5 Rate Your Level of Happiness. * 1 2 3 4 5 If You Could Make a Life or Career Change, How Confident Do You Feel About Making the Right Choice? * 1 2 3 4 5 How Confident Do You Feel About Your Future? * 1 2 3 4 5 If There is Something You Want to Change in Your Life Right Now, What is that? * What Does Your Dream Life Look Like? * Count Your Life Score If You Have 40 or Less Points, then you are a Candidate for Professional Coaching. Full Name * Email Phone If you are human, leave this field blank. Submit Δ{{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting…