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Q4 - PACT
Welcome!
Please get started by filling out this intake form. It gathers high level info about you and what you'd like to accomplish. It also asks for your commitment to working together.
* Indicates required question
Your first and last name
*
Your answer
Your email address
*
If you have a gmail address, please use it. If you don't, that's alright. This will only be used for coordinating meetings and calendar invites. If you would like to sign up for my biweekly emails, you can do so
here
.
Your answer
Your timezone
*
AT - Atlantic time
ET - Eastern time
CT - Central Time
MT - Mountain Time
PT - Pacific Time
Other:
Share your social media handles, if you like.
Your answer
ABOUT YOU AND YOUR GOALS
Tell me a little bit about who you are and what you do.
*
No need to be detailed, just a little bit is ok. :)
Your answer
Why are you interested in joining this group?
*
Just a short answer is good!
Your answer
Do you already have an idea of what your Q4 goals are?
*
It's ok if you don't. One of the things we can do together is develop your goals.
Yes!
Kinda
Nope
If "Yes" or "Kinda," please share a simple, high level summary.
*
No need to stress about this, just a sentence or two about what you want to accomplish.
Your answer
How confident do you feel in your ability to meet your goals? (With support, of course)
*
1
2
3
4
5
ABOUT WORKING TOGETHER
- We'll use asynchronous tools to keep each other updated on progress.
- We'll use a chat tool to communicate ad hoc.
- We'll schedule weekly video calls (date/time will be based on members' availability)
Are you committed to:
*
YES!!!
I'm not sure
That's too much for me
Working together for all of Q4 (Oct, Nov, Dec)?
Updating a shared document with your progress each week?
Being an active participant in the group chat?
YES!!!
I'm not sure
That's too much for me
Working together for all of Q4 (Oct, Nov, Dec)?
Updating a shared document with your progress each week?
Being an active participant in the group chat?
ABOUT BEING PART OF A SUPPORTIVE GROUP
Do you commit to:
*
Yes
I struggle with this
Actively listening to your peers?
Being compassionate and empathetic with your peers?
Being open minded and non-judgemental about your peers' choices and experiences?
Yes
I struggle with this
Actively listening to your peers?
Being compassionate and empathetic with your peers?
Being open minded and non-judgemental about your peers' choices and experiences?
What are your thoughts on unsolicited advice?
*
Your answer
Any questions for me?
Your answer
I'll be in touch within a day or two.
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