Strategic Readiness Diagnostic Request Form

Karlene Millwood International Inc.

Strategic Readiness Diagnostic Request Form
Purpose: This form initiates a request for the Strategic Readiness Diagnostic (SRI™).

KMI reviews each submission to assess leadership alignment, organizational context, and strategic fit. Selected organizations will be invited to a follow-up discussion to define scope and determine next steps.

The Strategic Readiness Diagnostic (SRI™) is a structured, paid engagement designed to ensure precision, alignment, and measurable outcomes before full advisory work begins.
Organization Information
Organization Name:*
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 are the key stakeholders or leaders relevant to this initiative? (Titles/roles only)*
Executive / C-SuiteSenior LeadersMid-Level LeadersCross-Functional Teams
Strategic Context
3. What leadership, cultural, or strategic challenges are currently impacting your organization’s performance?*
Leadership alignment and effectivenessStrategy execution and accountabilityLeadership capacity and advancementOrganizational culture and internal dynamicsCustomer or employee experience alignmentNot sure — requires diagnostic assessment
5. What outcomes or changes would define successfor your organization?*
Organizational Readiness
YesIn ProgressNot Yet
YesNo
If yes, please briefly describe:
Immediate (0–3 months)Near-term (3–6 months)Future planning (6–12 months)
Scope & Fit
Enterprise / organization-wideExecutive or senior leadership teamSpecific business unit or functionCross-functional teamsUnsure
$15K–$30K$30K–$60K$60K+To be defined
Additional Information
YesI would like more information before proceeding
12. Any additional context or considerations we should know?
Next Step

KMI will review your submission to assess alignment andstrategic fit. Due to the structured nature of the Strategic ReadinessDiagnostic (SRI™), not all requests will proceed. Selected organizations willbe contacted to discuss scope, alignment, and potential next steps.
Karlene Millwood International Inc.

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

Karlene Millwood International Inc.

Organization Information

Leadership Context

Strategic Context

Organizational Readiness

Scope & Fit

Additional Information

Next Step