KMI Executive Briefing Form

Karlene Millwood International Inc.

Executive Briefing Request Form
Purpose: This form supports an initial executive conversation to explore alignment, scope, and strategic fit. Executive briefings are designed for senior leaders and decision-makers considering leadership, strategic planning, or advisory engagements.
Organization Information
Organization Name:*
Sector:*

Public Sector / GovernmentCorporate / PrivateNon-Profit / Mission-DrivenFaith-BasedAssociation / EducationOther: __________________________
Website:*
Primary Contact Name:*

First NameLast Name
Title:*
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Leadership Context
1. Who will participate in the executive briefing?(Titles/roles only)*
2. What leadership level is primarily impacted?*

Executive / C-SuiteSenior LeadersMid-Level LeadersCross-Functional Teams
Strategic Focus
3. What prompted you to request this conversation at this time?*
4. Which areas are most relevant? (Select all that apply)*

Leadership Development & Capability Building (PRISM™)Strategic Planning & Execution Readiness (IMPACT™)Leadership Presence & Advancement Initiatives (EMERGE™)Customer/employee experience alignment (PRISM™ CX)Executive or team coachingKeynote or facilitated sessionNot sure — seeking guidance
Organizational Readiness
5. Is there senior leadership sponsorship for this initiative?*

YesIn ProgressNot Yet
6. Is this effort connected to a broader strategy or transformation?*

YesNo
7. If yes, please briefly describe:
8. Desired timeline:*

Immediate (0–3 months)Near-term (3–6 months)Future planning (6–12 months)
Engagement Scope
9. Anticipated engagement type:*

Enterprise / organization-wideLeadership cohortExecutive team onlyAdvisory / strategy supportUnsure
10. Budget range (helps determine fit and scope):*

$15K–$30K$30K–$60K$60K+To be defined
Additional Information
11. Any additional context or considerations we should know?
Next Step

Upon review, KMI will follow up to schedule a 30–45 minute executive briefing to discuss alignment, scope, and potential engagement pathways.Thank you for your interest in working with Karlene Millwood International Inc.
Karlene Millwood International Inc.

Principled Leadership. Strategic Clarity. Enduring Impact.
Should be Empty:

Karlene Millwood International Inc.

Organization Information

Leadership Context

Strategic Focus

Organizational Readiness

Engagement Scope

Additional Information

Next Step