Holistic Leadership Assessment

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.We will email you your scores.

example@example.com

3

Phone Number* This field is required.

Country Code

Area Code

Phone Number

4

I have self awareness.* This field is required.

YESNO

5

I know what my strengths are.* This field is required.

YESNO

6

I feel as though my contributions are gifts.* This field is required.

YESNO

7

I feel as if I have a sense of purpose.* This field is required.

YESNO

8

I know what my talents are.* This field is required.

YESNO

9

I am fearless.* This field is required.

YESNO

10

I have discipline.* This field is required.

YESNO

11

I have integrity.* This field is required.

YESNO

12

I have a sense of belonging.* This field is required.

YESNO

13

I have supportive relationships in my life.* This field is required.

YESNO

14

01 Being-ness TotalSection Total out of 10

15

I complete tasks with quality.* This field is required.

YESNO

16

I am creative in how I get things done.* This field is required.

YESNO

17

I have a sense of achievement.* This field is required.

YESNO

18

I spend some time each day creating something new.* This field is required.

YESNO

19

I am influential.* This field is required.

YESNO

20

I offer my insights.* This field is required.

YESNO

21

I am aware of trends in my industry.* This field is required.

YESNO

22

I have global knowledge.* This field is required.

YESNO

23

I have experience.* This field is required.

YESNO

24

I am a master of my skills.* This field is required.

YESNO

25

02 Doing-ness TotalSection Total out of 10

26

I work on personal growth.* This field is required.

YESNO

27

I am a leader.* This field is required.

YESNO

28

I can envision new ideas or solutions.* This field is required.

YESNO

29

I embrace my imperfections.* This field is required.

YESNO

30

I can be in the present moment.* This field is required.

YESNO

31

I set intentions for my life.* This field is required.

YESNO

32

I can let go.* This field is required.

YESNO

33

I have awareness of my internal landscape.* This field is required.

YESNO

34

I feel powerful.* This field is required.

YESNO

35

I read books about leadership practice or self help.* This field is required.

YESNO

36

03 Self Awareness TotalSection Total out of 10

37

I have a group of friends.* This field is required.

YESNO

38

I feel supported by my friends.* This field is required.

YESNO

39

I am engaged in social responsibility.* This field is required.

YESNO

40

I feel as though my participation makes a difference for others.* This field is required.

YESNO

41

I volunteer my time.* This field is required.

YESNO

42

I have access to other decision makers.* This field is required.

YESNO

43

I have a circle of diverse friends.* This field is required.

YESNO

44

I am part of a mentoring program.* This field is required.

YESNO

45

I engage in affinity or networking groups.* This field is required.

YESNO

46

I am part of a local or national organization.* This field is required.

YESNO

47

04 Social Surroundings TotalSection Total out of 10

48

I have recently called my parents. (If they are in non-physical form select yes)* This field is required.

YESNO

49

I get along with my siblings. (If you're an only child, then mark yes)* This field is required.

YESNO

50

I do what I say I will do.* This field is required.

YESNO

51

I send people grace instead of jugde their situations.* This field is required.

YESNO

52

I voice my needs.* This field is required.

YESNO

53

I speak up when I observe injustice.* This field is required.

YESNO

54

I do not complain.* This field is required.

YESNO

55

I tell the truth.* This field is required.

YESNO

56

I spend time with people I enjoy.* This field is required.

YESNO

57

I do not gossip.* This field is required.

YESNO

58

05 Interpersonal Relationships TotalSection Total out of 10

59

I have a spiritual practice.* This field is required.

YESNO

60

I say "grace" at meals, or am grateful daily.* This field is required.

YESNO

61

I have willpower to make choices.* This field is required.

YESNO

62

I am aware of my attitudes and belief systems.* This field is required.

YESNO

63

I feel in harmony with myself.* This field is required.

YESNO

64

I believe in cause and effect.* This field is required.

YESNO

65

I am not a victim and am in charge of my day.* This field is required.

YESNO

66

I can separate myself from my fears.* This field is required.

YESNO

67

I do not give my power away.* This field is required.

YESNO

68

I live in the present moment.* This field is required.

YESNO

69

06 Spiritual Practices TotalSection Total out of 10

70

I save some of my money.* This field is required.

YESNO

71

I have a salary or income.* This field is required.

YESNO

72

I have skills to make money on the side.* This field is required.

YESNO

73

I live within my means.* This field is required.

YESNO

74

I have access to bank loans or investors.* This field is required.

YESNO

75

I use a budget for my expenses.* This field is required.

YESNO

76

I own assets.* This field is required.

YESNO

77

I pay my bills on time.* This field is required.

YESNO

78

I file my taxes.* This field is required.

YESNO

79

I feel worthy of abundance.* This field is required.

YESNO

80

07 Financial Health & Abundance TotalSection Total out of 10

81

I shower every day.* This field is required.

YESNO

82

I wear deodorant.* This field is required.

YESNO

83

I wear clean clothes.* This field is required.

YESNO

84

I brush my teeth at least twice a day.* This field is required.

YESNO

85

I know the status of my health (by visiting a healthcare professional or healer)* This field is required.

YESNO

86

I eat well.* This field is required.

YESNO

87

I am happy with my weight.* This field is required.

YESNO

88

I do not smoke.* This field is required.

YESNO

89

I sleep at least eight hours each night.* This field is required.

YESNO

90

I take "me" time.* This field is required.

YESNO

91

08 Personal Health & Hygiene TotalSection Total out of 10

92

I manage my stress.* This field is required.

YESNO

93

I exercise.* This field is required.

YESNO

94

I focus on one thing at a time.* This field is required.

YESNO

95

I sleep well.* This field is required.

YESNO

96

I do not feel ashamed.* This field is required.

YESNO

97

I have a positive attitude.* This field is required.

YESNO

98

I know how to let down and relax.* This field is required.

YESNO

99

I do something nice for myself on a regular basis.* This field is required.

YESNO

100

I work with my breath and/or meditate.* This field is required.

YESNO

101

I set parameters/boundaries.* This field is required.

YESNO

102

09 Self-Care Practices TotalSection Total out of 10

103

My house is clean.* This field is required.

YESNO

104

I live in a safe environment.* This field is required.

YESNO

105

My car is clean and without trash.* This field is required.

YESNO

106

My living space feels comfortable.* This field is required.

YESNO

107

I have access to the internet and a computer.* This field is required.

YESNO

108

I do not have the storage for things that I do not access/require.* This field is required.

YESNO

109

My work space is clean and organized.* This field is required.

YESNO

110

My kitchen is clean, and I have a place and the equipment to cook.* This field is required.

YESNO

111

My bathroom(s) are cleaned on a regular basis.* This field is required.

YESNO

112

I change my sheets and towels on a regular basis.* This field is required.

YESNO

113

10 Physical Surroundings TotalSection Total out of 10

114

Total ScoreAdding up the 10 sections...out of 100 total points

115

DateIf you keep track of your scores by date, you can analyze your results on a monthly, quarterly, annual basis.

Date