Achieve More LLC Inquiry and Insights Form

Inquiry and Insights Form

Welcome!

Please take 3-5 minutes to reflect briefly on your needs, successes, and challenges.

Share any specific issues, opportunities, or questions you'd like to explore. We will use your feedback to determine

opportunities for future focus.

The information remains confidential.

©AchieveMore LLC – www.achievemorellc.com

Mariama S. Boney, LMSW, CAE, CPEC

mboney@achievemorellc.com

www.calendly.com/mariamab
Email*
example@example.com
Name*

First NameLast Name
Direct Phone Number*
Organization/Title/Role
How would you characterize your current DEI, Leadership, or Wellbeing needs? (check all that apply)*

Board/Chapter DevelopmentBook Talk/ReadingConsulting/PlanningCoaching (Personal/Professional/Board)Crisis Intervention/Incident ResponseDEIA+A FoundationDialogue (Restorative or Leadership)Education/Learning/TrainingInclude Me: Email List (We only send periodic updates)Facilitation/ModeratingInclusivity CalendarInspiration/HopeMember DevelopmentMulticultural/DEI MessagingPublic Speaking/Keynote/Featured WorkshopPrayer/PraisePlanning/StrategySelf-care/Well-being/WellnessOther
1. What goals, needs, interests, or issues do you have that we can address or assist you with? *
2. How well are you achieving the leadership, DEIA+A, team, well-being, or organizational goals/targets?*
3. In the past 6-months, what is one or two primary successes and challenges have occurred? What opportunities exist?*
4. Current Level of Trust and Transparency*

Rate your perception of the current level of psychological safety, openness, and confidence that exists in the organization, within the team, or with stakeholders. A 1 star rating is low vs. a 5 star rating is high.
5. Readiness for Small Steps Toward Transformation*

Rate your openness, commitment, and capacity to be involved in the growth and change leadership process or journey. And a willingness to move through excitement as well as disappointment. A 1 star rating is low vs. a 5 star rating is high.
6. Who is accountable for the progress and small steps toward transformation?*
List role(s) or title(s)
7. Where are you on your learning, planning, or dialogue journey?*

OngoingRecently startedJust beginning
8. Is your desired state fully supported by all partners?*

YesSomewhatNot reallyUnsure
Is there a specific date(s), time(s), or timeframe? How many people will be involved ?*
Share Approximate Dates and Details or To Be Determined
What is your budget range?*
Approximate budget range or To Be Determined
Any comments or additional insights on what you hope to accomplish?
Should be Empty: