HER Evolution Program Questionnaire 2022

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Cell Number* This field is required.
4
Preferred Pronouns
5
Occupation
6
City, State
7
Age Range
18-25
26-35
36-45
46-55
56-65
66+
8
How did you hear about Zuri Walker Coaching/The HER Evolution?
Facebook or Instagram
Zuri's Mailing List
Referral/Friend
Podcast
Other
9
Why is it important for you to complete this coaching program? Why now?* This field is required.
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Ok
10
What three outcomes would you like to create for yourself as a result of this coaching program? Be specific.* This field is required.
11
What are the biggest challenges/struggles that you face today?* This field is required.
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Large
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Ok
12
Are you prepared to see and work with the real you, even the challenging or scary parts?
Yes, absolutely!
Maybe; I need to know more of what that looks like.
No, not ready for all that just yet.
I'm not sure; change is hard for me.
13
Are you willing and prepared to make real changes to your life where needed?
Yes, absolutely!
Maybe; I need to know more of what that looks like.
No, not ready for all that just yet.
I'm not sure; change is hard for me.
14
What barriers do you anticipate may hold you back from successfully transforming during this program? What are you willing to do to address/overcome these barriers?* This field is required.
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Ok
15
What holds you back from creating the life you most desire?* This field is required.
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Ok
16
Are you comfortable showing up and participating in a small group format? Are you willing to receive support and be supportive to others along this journey? Please explain.* This field is required.
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Ok
17
If you are approved for the program, are you able to commit to regularly attending weekly sessions for the next 100 days?* This field is required.
Yes
No
I'm not sure...
18
This program is an investment of $3,000. Are you ready and willing to invest in yourself and your transformation?* This field is required.
Yes, I'm SO ready!
Yes, but I would like to explore financing options.
Maybe; I still have questions I would like to have answered.
No, I don't think this program is a match for where I am today.
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