Women of Purpose & Power Programming Survey
Thanks for taking a few minutes to fill out this form and help provide valuable insights to aid in crafting only the most relevant and supportive programming. Your openness and thoughtful replies are deeply appreciated.
Sign in to Google to save your progress. Learn more
Email *
Name *
Birthdate *
MM
/
DD
/
YYYY
Location *
Phone number ( if you'd like to get occasional inspirations)
Getting to know you
The following questions will help us better understand your specific needs and desires.
What are your goals, dreams and desires for yourself? Think both personally & professionally. *
What's stopping you from achieving these goals or getting in the way? *
What feels like the biggest challenge/road block in your life right now? *
What would ideal support look like? *
How might this group contribute to some of that ideal support? (share any specifics you might like to receive such as positive messaging, reflective prompts, accountability, workshops, connection and community building, etc) *
Programming
What types of programming/engagement are you most interested in?
Online Community
Themed in person Meetups
Themed virtual Meetups
Half and full day workshops
Retreats
Tools & Resources
Regular encouragements and inspiration
1:1 coaching
Long term group program (6-12months long)
Really interested in
Interested in
Somewhat interested in
Not interested in at all
Clear selection
On a scale of 1 to 5 ( 1 meaning that it is not an issue and 5 meaning it is something you think about often or which causes great challenge in your life) please rank the following common concerns amongst changemakers. *
1
2
3
4
5
Burnout
Overwhelm
Healthy work/life balance
Finding purposeful/values-aligned work
Staying focused
Making small and consistent behavior changes
Navigating structural work dynamics
Navigating interpersonal relationship dynamics
Navigating conflict in general
Showing up authentically
Allyship ( wanting to support people from backgrounds different than yours)
Identity ( exploring who you are in relation to and outside of common identities such as race, gender, nationality, etc. )
Feeling personal responsibility to transform the world
Feeling alone or isolated
Imposture syndrom
Trauma
Compassion Fatigue
Mental Health
Building mutually reciprocal relationships of depth
What other themes or areas would you like to receive support in? *
How would your life be different than it currently is if you had the support you needed? *
If there is anything else you'd like to share regarding your needs or support you'd like to receive please list below.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Akwése Enterprises. Report Abuse
Google Forms