Happy & Hopeful Pre-Assessment Form

1

Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Facebook Profile NameIf not on FB, please type 'NA'

5

What made you interested in signing up for the Happy & Hopeful, Healing Journey?* This field is required.

6

What are you hoping to accomplish after completion of the Happy & Hopeful Healing Journey?* This field is required.

7

What challenges or barriers are currently preventing you from reaching your goals?* This field is required.

8

How committed are you to making changes in your life to achieve your goals?* This field is required.

Very committed

Somewhat committed

Not sure

Not committed

9

How would you rate your current level of emotional well-being?* This field is required.Are you able to regulate your emotions? Understand your emotions?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

10

How would you rate your current level of mindset/thoughts/mental health?* This field is required.Are your thoughts typically negative? Are you able to control your thoughts? Can you see other points of view?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

11

How would you rate your current level of financial well-being?* This field is required.Are you financially stable? Able to provide for your family independently?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

12

How would you rate your current level of relationships/connections/social well-being?* This field is required.Do you have a community you feel connected to? Do you have healthy relationships with friends or family?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

13

How would you rate your current level of spiritual well-being?* This field is required.Do you spend quiet time with God? Do you feel connected to your soul or the Holy Spirit?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

14

How would you rate your current level of personal growth?* This field is required.Are you always learning something new? Challenging yourself? Taking up a new hobby?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

15

How would you rate your current level of being of service to others?* This field is required.Do you volunteer? Help others frequently? Teach? Mentor?

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

16

How would you rate your current level of satisfaction with your life overall?* This field is required.

Very satisfied

Satisfied

Neutral

Dissatisfied

Very dissatisfied

17

Do you feel like you have freedom?Are able to do the things you want to do, or enjoy doing, when you want to do them (for the most part)?

YESNO

18

How would you rate your current level of satisfaction with how you are parenting and showing up for your kids?* This field is required.

Very good

Good

Neutral

Dissatisfied

Very dissatisfied

19

How would you rate your current level of emotional stress due to the challenge of forgiving past hurts?* This field is required.

High

Neutral

Low

20

How would you rate your current level of emotional pain due to unhealed wounds?* This field is required.

High

Neutral

Low

21

How would you rate your connection/relationship to God?* This field is required.

High

Fair

Low

No Relationship

22

Do you acknowledge Jesus Christ as your Lord and Savior?* This field is required.

Yes

Unsure, But Interested to Learn More

No

23

How supported do you feel as a single mom?* This field is required.

Highly Supported

Somewhat Supported

Low Level Support

No Support

24

Do you commit to do the hard work for 10-weeks in order to heal, be happy, restore your hope, love yourself again, and show up as a better parent?

YESNO

25

Type your name here if you

26

Is there any additional information you would like to share with Single Moms Sorority before beginning the Happy & Hopeful Course that would be important for us to know?* This field is required.