2022 Makers Mastermind Intake Form
In order to best serve you during the next 12-months, I need to get to know you and your business better. Please take the time to answer these questions to the best of your ability.
Sign in to Google to save your progress. Learn more
Email *
1. What is your full name, and what do you like to go by? *
2. Which age group best describes you? *
3. What is your mailing address? *
4. When is your birthday? *
MM
/
DD
/
YYYY
5. When is your business anniversary? *
MM
/
DD
/
YYYY
6. What is your business website? *
7. Do you have any “in progress” websites? If so, list them!
8. What social media platforms are you on and what are your handles? *
9. What products have you purchased from me in the past? Check all that apply. *
Required
10. Please provide, in detail, your primary source of income; in other words, what do you do every day to pay your bills? (i.e. spouse, 9-5, MLM, full time entrepreneur) *
11. Please provide, in detail, your “dream” source of income. With all obstacles removed, what would you do every day to generate income? (Feel free to dream BIG here - if the answer is to "travel around in an RV with your fur babies" - let me know!) *
12. What are some roadblocks standing in the way of this ‘dream’. Remember, roadblocks are not just physical (time, supplies, websites) roadblocks are also mindset related (fear, lack of support, previous failure). *
13. Have you enrolled in any business coaching or mastermind programs before? *
14. If so, which masterminds did you complete? (no judgement, life happens!)
15. What was your biggest obstacle in implementing / executing what you learned there? *
16. How did you hear about my consulting services? *
17. What is the main reason you signed up for my mastermind services? *
18. Which of the following best describes the current stage of your business? *
19. Do you love, like, or hate your job? *
20. What type(s) of products does your business currently offer? *
21. What industry is your side hustle business in? *
22. Is your business Product Based or Service Based? *
23. What do you make or sell in your business? *
24. On average, how much (gross) income does your business currently generate? *
25. What’s your number one priority for your business? *
26. What options have you looked at to achieve your goal? *
27. What do you believe needs to be strengthened in order to support achieving your goal? *
28. What’s unique about your business compared to your competitors? *
29. Are you committed to putting in the work even if you’re unsure of the outcome and scared to try something new? *
30. If I were to come to your house, how would we spend our time together? *
31. What one word best describes you? *
Do you have any dietary restrictions? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of SC Mail. Report Abuse
Google Forms