Mailchimp Survey

Getting Started

This questionnaire is for executives experiencing significant changes to their personal and professional lives as they get older. It should not take more than 10 minutes to complete.
At the end of the survey, you will be provided with the option of setting up a time to talk with one of the coaches at EXECUTIVES OVER 50.
Regardless of whether you book a time or not, you will receive a report of your results compared to those of the broader sample set within 24 hours of submitting your answers.
EXECUTIVES OVER 50 handles all personal information with the utmost confidentiality.
First Name
*
Last Name
*
Age
*
Email Address
*
The next two questions are more general in nature. After that, we will ask you about your current professional situation.
What provides you currently with the greatest pleasure/joy? (Check all that apply)
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My immediate family (eg. spouse, parents, children)
A significant other
Good friends
My career/job/profession
Volunteer work
Travelling
Reading
Sports
Restaurants and cooking
Theater, concerts, movies and other arts and entertainment-related activities
Other
What do you consider to be your greatest challenge(s)? (Check all that apply)
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Lack of meaningful relationship(s)/loneliness
My love life
My physical health
My mental health (eg. depression, anxiety, etc. or worse)
My job, career or business
Dealing with aging parents
Ageism or other forms of discrimination
Finances
Feeling that my best years are behind me
Little hope for the future
Other
What is your current employment status?
*
EmployedLong-term Unemployed (>1 year)Short-term Unemployed (<1 year)Independent contractor/SolopreneurBusiness ownerStudentStay at home father/motherRetiredOther
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
If you are still working, 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.)?
How would you rate your current financial situation?
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0 is I'm destitute
10 is I have more money than I'll ever need
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I'm destitute
I have more money than I'll ever need
Have you experienced age discrimination in the workplace - eg. with peers, bosses, members of your teams, clients, suppliers, etc. - during the last five years?
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yesno
If yes, please click on as many of the situations you experienced that you believe were because of your age.
I was passed over for a promotion
I found myself getting excluded from certain meetings and conversations
I was asked to "retire"
I was fired
My span of reponsibilities has been shrinking
My age was openly discussed in front of me
I discovered my age was the subject of conversations behind my back
Other
What did you do about this? (Check as many as apply)
Nothing
I raised this issue with my boss and/or HR
I resigned
I sued the company and/or individuals involved
I wrote or spoke about my experience on social media and/or other platforms
Other
Was the issue resolved to your satisfaction?
YesNo
Please provide any other details about your current professional life you would like to share.
But we all know there’s more to life than just working. Since happiness often has more to do with satisfying private lives than our professional lives, the next section focuses on the personal.
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
012345678910
Couldn't be worse
Couldn't be happier
What’s your current marital status?
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MarriedDivorcedPartneredSingle Other
Please check as many boxes as possible that correspond to the current state of your health.
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Have never been so healthy
I have had one or more unexpected "health scares" in the last five years
I've had an accident in the last five years that has impaired my ability to function as well as I used to. (This includes falling, being in a car, bike or plane accident, etc.)
I'm feeling my age
I have a chronic but manageable illness
I have a life-threatening disease
Other
Please provide any details about your current personal life you would like to share.
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
012345678910
Totally at a loss
I'm a master at change
Is there anything else you think we should know about you?
Would you like to speak to an Executives Over 50 coach/consultant?
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YesNoNot sure
if you answered “yes”, please feel free to book a time to speak with us using the link below. If you’d rather have someone follow up with you directly, please provide the best number for us to contact you at below.
Executives Over 50 calendar
Telephone number