Mailchimp Survey

Getting Started

Thank you for your interest in Executives Over 50.
This questionnaire is the first step in getting to know you, your current professional and personal life situations as well as experience working with a group and/or a coach.
Once you have submitted your finished application, we will be in touch to talk more specifically about some of the changes and challenges your are facing and whether there is a fit between your needs and what we do at EOVR 50.
We handle everything with the utmost confidentiality and nothing in this application will be shared with anyone other than the EOVR 50 team.
First Name
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Last Name
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Age
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Email Address
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Telephone number
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What’s your current marital status?
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MarriedDivorcedPartneredSingle Other
On a scale of 1 to 10, how would you rate your current level of satisfaction with your personal life?
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0 is Couldn't be worse
10 is Couldn't be happier
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Couldn't be worse
Couldn't be happier
What is your current employment status?
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EmployedLong-term Unemployed (>1 year)Short-term Unemployed (<1 year)Independent contractor/SolopreneurBusiness ownerStudentStay at home father/motherRetiredOther
If you are currently employed or a business owner, what is your title (eg. VP of Sales, CEO, COO, Director of Operations, etc.)?
If you are currently unemployed or retired, what was your last title (eg. VP of Sales, CEO, COO, Director of Operations, etc.)?
On a scale of 1 to 10, how would you rate your current level of satisfaction with your professional life?
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0 is Couldn't be worse
10 is Couldn't be happier
012345678910
Couldn't be worse
Couldn't be happier
Please provide us with some detail about the most important issues and untapped opportunities you are facing. (This should cover areas like finance, physical, mental or psychological health, employment/career, relationships, ageism/other forms of discrimination, etc.) Answers should be between 50 and 250 words long.
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How would you rate your overall level of confidence in your ability to make successful personal and professional changes to your life?
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0 is Totally at a loss
10 is I'm a master at change
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Totally at a loss
I'm a master at change
Have you ever been a member of a peer advisory group before? (A “peer advisory group” is a group of people who meet regularly to support every member through personal change or transformation - for example, the achievement of certain goals, improving and/or getting rid of bad habits and addictions, resolving difficult situations, etc.)
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yesno
If yes. how would you rate that experience?
0 is Disastrous
10 is Best thing I've ever done
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Disastrous
Best thing I've ever done
If no, how comfortable are you with the idea of being advised by or giving advise to members of a peer-to-peer advisory group?
Very comfortableComfortableNot very comfortableDoesn't work for me
Have you ever worked with a (life/career/business) coach before?
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yesno
If yes, how would you rate that experience?
0 is Disastrous
10 is Best thing I've ever done
012345678910
Disastrous
Best thing I've ever done
If no, how comfortable are you with the idea of working with a life/business/career/health & wellbeing coach?
Very comfortableComfortableNot very comfortableDoesn't work for me
Additional comments
On a scale of 1 to 10, how effective do you think an advisory board of peers is using a platform like Google Meet or Zoom for meetings compared to in-person?
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0 is Disastrous
10 is Superior to in-person
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Disastrous
Superior to in-person
How important is it to you to have a peer-to-peer advisory board that is comprised of individuals who are in a similar age range?
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Very importantImportantLess importantNot important
Is there anything else you think we should know about you?