Corporate Influencer Program x Northwestern Mutual Intake Questionnaire
Name
First Name
Last Name
Email
example@example.com
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Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Which best describes you?
Entrepreneur / Business Owner
Corporate Professional (9–5)
Creative / Influencer
Investor / Financial Professional
☐ Other: __________
What stage is your business or career currently in?
☐ Launching
☐ Growing / Scaling
☐ Established and Expanding
☐ Corporate Leadership / Executive
What are your top 3 business or financial goals over the next 12 months?
Have you ever worked with a financial advisor or planner before?
☐ Yes
☐ No
On a scale of 1–5, how would you rate your current financial systems and structure?
1 – Needs improvement
Some structure, not consistent
Organized, but not scalable
Fully optimized and automated
Which financial areas would you like support in? (Select all that apply)
Budgeting & Cash Flow Management
Business Credit / Funding
Retirement / Legacy Planning
Insurance / Protection
Investments
☐ Tax / Legal Structuring
Would you like to schedule a complimentary Financial Strategy Appointment with a Northwestern Mutual representative?
☐ Yes, please schedule me now
Yes, follow up after the event
No, not at this time
Which area of the Corporate Influencer Program are you most interested in?
Brand Development
Scaling / Systems & Operations
Financial Strategy & Structure
PR, Marketing, and Visibility
Partnerships & Sponsorships
What’s your biggest challenge right now in scaling your business or career?
Are you currently looking to collaborate, partner, or sponsor future events?
☐ Yes
☐ No
☐ Possibly — send me more info
Event & Experience Feedback
The Panels & Workshops
Networking Opportunities
☐ VIP Lunch
How did you hear about the event?
☐ Friend / Partner Referral
☐ Social Media
☐ Email / Newsletter
☐ Northwestern Mutual
☐ GOAT Ave Inc / Elevate Up Global
Would you like to be featured in post-event media or case studies?
☐ Yes
☐ No
Preferred Follow-Up Method:
☐ Phone
☐ Email
☐ Text
Best Time to Reach You:
Morning
Afternoon
Evening
Are you open to a financial planning consultation to align your business and personal goals?
Yes, schedule now
Yes, follow up later
No
If you could achieve one major breakthrough in your business or finances in the next 90 days, what would it be?
Do you have any allergies?
Are you interested in attending Day 2 for content creation, Q1 planning, and campaign build-out?
Yes, I want to participate in Day 2
No, I’ll only attend Day 1
Maybe — send me more details
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