Please fill out this form and submit before your Workshop.
This questionnaire has been designed to support you in maximizing the results you produce in the ChoiceCenter Trainings. The more you put into the training, the more you will get out of it. Most people find that their experience is enhanced if they spend some time reflecting upon the important areas of their life prior to beginning the training.
If you have already decided which goals you want to achieve in each of the following areas, we invite you to take this opportunity to clarify them even more. To complete this sheet, we recommend that you establish a time when you can focus, be calm and look inside yourself.
In each one of the following areas, describe
(a) goals already achieved
(b) goals, ideas or 'dreams' that you would like to create in the future (even if you think they are hard or impossible to reach)
(c) considerations you have regarding these goals that you actually think are limiting your achieving them (for example: fear, laziness, lack of money, time etc.)
Any questions regarding this homework, please contact us at (702) 838-3988.
Please fill out the electronic form below and CLICK SUBMIT to send to ChoiceCenter, or you may DOWNLOAD THE PDF HERE and mail or fax to ChoiceCenter at firstname.lastname@example.org or 702.974.0684.
BUSINESS / CAREER
FAMILY / PERSONAL RELATIONSHIPS
EDUCATION / PERSONAL GROWTH
LEISURE / RECREATION / HOBBIES
CONTRIBUTION / WAYS YOU GIVE BACK
HEALTH / BODY / FITNESS
You have finished the Goals Section. Please select "NEXT" to go to the Welcome section.
CONFIDENTIAL HEALTH INFORMATION
Please answer all of the following questions completely. Your answers will be kept confidential.
The information you provide here will enable our trainers and staff to better support your participation. If during the training, you find yourself feeling uncomfortable to an excessive degree, you should report this immediately to the trainer or to a staff member.
If you have any questions about the appropriateness of your participation at this time, please consult a trained professional. In some cases, as instructed in the next section of this form, we require that you do so in order to participate in the training.
If you answered "Yes" to questions 5, 6, 7 or 8, read and follow the directions in Section B.
You have finished the Confidential Health Information Section. Please select "NEXT" to go to the Emergency Contacts section.