1
2
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NUMBER OF AREAS
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TOTAL
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= SCORE
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SCORE LEVEL
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Token
Unique token for entry
Are you in a relationship with a significant other?
(Required)
Yes
No
We ask this in order to filter the specific questions you’ll be asked on the assessment.
Do you consider yourself a spiritual person?
(Required)
Yes
No
We ask this in order to filter the specific questions you’ll be asked on the assessment.
Choose the phrase from each group that best describes you
Which best describes you?
(Required)
MIND1
Open to personal growth
Content with current state
Actively pursuing personal growth
Which best describes you?
(Required)
BODY1
Out of shape
Best shape of my life
Physically fit
Which best describes you?
(Required)
LOVE1
Investing in my relationship
Disconnected in my relationship
Sometimes investing in my relationship
Which best describes you?
(Required)
FAMILY1
Highly engaged with my family
Disengaged with my family
Sometimes engaged with my family
Which best describes you?
(Required)
SPIRIT1
Feel disconnected spiritually
Feel connected spiritually
Occasionally feel connected spiritually
Which best describes you?
(Required)
COMMUNITY1
Surface-level friends
Close friends
Lonely
Which best describes you?
(Required)
MONEY1
Making barely enough
Don’t make enough
Happy with what I earn
Which best describes you?
(Required)
HOBBIES1
Actively involved in one or more hobbies
Dabbling in a hobby or two
Unmotivated to pursue any hobbies
Which best describes you?
(Required)
WORK1
Performing poorly at work
Consistently performing at my best at work
Inconsistently performing at work
Which best describes you?
(Required)
BODY2
Somewhat active
Mostly inactive
Physically active
Which best describes you?
(Required)
SPIRIT2
Intentional spiritually
Drifting spiritually
Lukewarm spiritually
Which best describes you?
(Required)
COMMUNITY2
Intentionally cultivate diverse relationships
Tend to surround myself with people just like me
Appreciate diversity but don’t intentionally seek it out
Which best describes you?
(Required)
MIND2
Open (but not proactive) learner
Voracious learner
Fine with the status quo
Which best describes you?
(Required)
WORK2
Unfulfilled by career
Fulfilled by career
Fulfilled by some parts of career
Which best describes you?
(Required)
MONEY2
Financially unsure
Financially stressed
Financially confident
Which best describes you?
(Required)
HOBBIES2
All work and no play, baby
Always make time for my hobby or hobbies
Sometimes make time for my hobby or hobbies
Which best describes you?
(Required)
LOVE2
Constructive conflict with my spouse or partner
Sometimes constructive conflict with my spouse or partner
Destructive conflict with my spouse or partner
Which best describes you?
(Required)
COMMUNITY3
Friends who enable my bad habits
Friends who challenge me to grow
Friends who encourage but don’t challenge
Which best describes you?
(Required)
BODY3
I don’t care about what I eat
I focus on healthy eating
I try to eat healthy when I can
Which best describes you?
(Required)
MIND3
Mindful
Scatterbrained
Somewhat aware
Which best describes you?
(Required)
SPIRIT3
Feel purposeless
Feel purposeful
Feel purposeful but sometimes confused
Which best describes you?
(Required)
FAMILY2
Fully present with family
Sometimes attentive with family
Preoccupied while with family
Which best describes you?
(Required)
HOBBIES3
Entertained by hobbies
Bored
Enriched by hobbies
Which best describes you?
(Required)
WORK3
Career momentum
Career stagnancy
Slow career growth
Which best describes you?
(Required)
BODY4
Somewhat rested
Tired
Energetic
Which best describes you?
(Required)
MIND4
Scarcity mindset
Abundance mindset
Sometimes abundance, sometimes scarcity
Which best describes you?
(Required)
FAMILY3
Usually experience family conflict
Usually experience family harmony
Experience a lot of both family harmony and conflict
Which best describes you?
(Required)
SPIRIT4
Not plugged into a faith community
Active in a faith community
Sometimes attend a faith community
Which best describes you?
(Required)
HOBBIES4
Always on
Unplugged while pursuing hobbies
Sometimes unplugged while pursuing hobbies
Which best describes you?
(Required)
LOVE3
Somewhat aware of my spouse or partner’s needs
Aware of my spouse or partner’s needs
Clueless about my spouse or partner’s needs
Which best describes you?
(Required)
MONEY3
Have solid budget
Have no budget
Have budget but struggle sticking to it
Which best describes you?
(Required)
LOVE4
On the same page with my spouse or partner
Reading completely different books
Reading the same book but different pages
Which best describes you?
(Required)
FAMILY4
Try my best in my relationships with family
Intentional in my relationships with family
Rarely think about my relationships with family
Which best describes you?
(Required)
COMMUNITY4
Somewhat involved in community
Uncommitted to community
Deeply involved in community
Which best describes you?
(Required)
MONEY4
Nothing to spare
Sometimes financially generous
Financially generous
Which best describes you?
(Required)
WORK4
Sometimes challenged, sometimes bored at work
Overworked
Appropriately challenged at work
Name
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