Date

Name

Email

What is your primary personal growth goal?

What challenges do you face in achieving this goal?

Please select all that apply:

• Lack of time

• Limited resources

• Unclear direction

• Low motivation

What type of support would be most helpful?

• Guidance/Coaching

• Educational resources

• Accountability partner

• Tools/Technology

How much time can you dedicate weekly?

• 1-3 hours

• 3-5 hours

• 5-10 hours

• 10+ hours

Additional Information

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