Name
(Required)
First
Last
Email
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Section 1: Purpose
1. Why did you decide to enroll in Leadership Learning & Execution?
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2. List one specific thing you want to learn, reinforce, or change as a result of this course.
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3. What outcomes are you hoping for at the end of this course?
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4. Ninety days from now, how will you be able to tell whether you achieved these outcomes?
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5. What has been the primary focus of your life so far? Where have you invested your time and energy?
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6. Complete the following sentence: “As I understand it at the present time, my purpose in life is to…” (Focus on what you do, why you do it, and how. If you have a Life Purpose Statement, you can write it here.)
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7. What are the difficulties you regularly face that prevent you from living wholeheartedly for God? What do you tend to put ahead of fully living your purpose?
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Section 2: Gifts
8. What do you like to do? (For example: organize, persuade, teach, strategize, problem-solve)
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9. What tools do you like to work with? (For example: ideas, numbers, charts, concepts, machines)
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10. What triggers you to action? (For example: fear of loss, identification of a need, desire to please others, recognition, the urgency of a cause, desire to grow in authority, a desire for status, the need to overcome obstacles)
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11. How do you relate to others? (For example: team player, individualist, organizer, peacemaker, coordinator)
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12. Each person works best when motivated by certain factors. Your motivating factors are… (Check two)[2]
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Encountering problems to solve
Discovering disorder that needs organizing
Working with rules, principles, or policies
Meeting someone with a great idea
Engaging information or statistics
Getting feedback, applause, or response
Encountering a risky situation
Getting involved in situations that can stand improvement
Encountering ignorance and supplying information
Encountering a need for communication
Discovering an entrepreneurial opportunity
Encountering conflict
Bumping into a challenging situation
Encountering certain kinds of equipment or tools
13. Thinking back into your life as far as you can, list ten things you accomplished that gave you a tremendous sense of satisfaction. (Focus not on things you participated in as much as times where you took an action.) Please number in your response 1-10.
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14. What is unique about the circumstances of your life?
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Section 3: Beliefs
15. What are your most important beliefs about life?
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16. What are your beliefs about training others to be leaders?
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17. What beliefs about yourself block your being an effective mentor to emerging leaders?
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18. What would you most like to see happen in the world around you?
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Section 4: Mentoring
19. Who are the people who have had the biggest impact on your life?
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20. Who in history do you admire the most, and why?
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Section 5: Vision and Mission
Assessing your own credibility (Note: below are 13 word pairs, such as "Experienced/ Inexperienced." Select the point on each line indicating which word best describes you in relationship to the main leadership role in your life. For example, if you feel that you are somewhat experienced, then select the button "3" right in the middle, as follows.)
21. Am I competent? Do potential followers believe I will be a good leader?
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1
2
3
4
5
1 = Inexperienced 5 = Experienced
2/13
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1
2
3
4
5
1 = Uninformed 5 = Informed
3/13
(Required)
1
2
3
4
5
1 = Unskilled 5 = Skilled
4/13
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1
2
3
4
5
1 = Beginner 5 = Expert
5/13
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1
2
3
4
5
1 = Untrained 5 = Trained
22. Am I trustworthy? Can potential followers be sure I will treat them with dignity and integrity?”
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1
2
3
4
5
1 = Cruel 5 = Kind
7/13
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1
2
3
4
5
1 = Unfriendly 5 = Friendly
8/13
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1
2
3
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5
1 = Dishonest 5 = Honest
9/13
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1
2
3
4
5
1 = Unempathetic 5 = Empathetic
23. Am I dynamic? Am I capable of going to bat for what is really important?
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1
2
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1 = Hesitant 5 = Aggressive
11/13
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1
2
3
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5
1 = Sheepish 5 = Responsive
12/13
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1
2
3
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5
1 = Timid 5 = Bold
13/13
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1
2
3
4
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1 = Passive 5 = Active
24. If your life could be exactly the way you want it, what would it be like? How would you spend your time and energy?
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25. What would you want your ideal day to look like?
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(Sketch it out hour by hour or by detailed blocks)
26. What would you want your ideal week to look like?
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(Sketch it out day by day)
27. What extra commitments, promises, projects or stuff do you have in your life that if you got rid of them would give you the freedom to be more effective?
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28. What legacy do you want to leave for others when you’re gone?
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29. What actions will you take within the next 10 days?
(Required)
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