1.    How do you define success?

            Family        

            Community  

            Work          

2.    Are you achieving balance in your work and home life? Yes  No

3.    Are you enjoying what you do?  Yes  No

4.    Would you like to improve the focus and direction of where your business and personal life are heading?  Yes  No

5.    Do you have a business plan, vision or mission statement?  Yes  No

6.    Have you developed a marketing plan for your business?  Yes  No

7.    Do you have financing for startup/expansion costs?  Yes  No

8.    Are your business and personal life adequately insured?  Yes  No

9.    Do you have the right TEAM to make your business a success?  Yes  No  Not Sure

10.   Have you developed strategies to make your business more profitable?  Yes  No

11.   Do you have an advisory board for the sharing of ideas?  Yes  No

12.   Do you have the correct systems in place to make your business a success?  Yes  No  Not Sure

13.   Do you have a succession plan for your business?  Yes  No

Please provide the following information so we may contact you:

Organization Name:

Contact Name:   

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