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.
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