Welcome to Kaizen Summit!

This self-assessment form will help us understand your current challenges, goals, and aspirations so that we can match you with the most suitable mentor. Please answer honestly and in as much detail as possible.

Personal Information

Your Current Situation

What are the key challenges or pain points you’re currently experiencing?

Lack of direction in personal/professional life

Stress management or burnout

Struggling with physical fitness or health goals

Balancing work, family, and personal responsibilities

Building leadership skills

Other

Please specify:

What motivated you to seek mentorship?

On a scale of 1 to 10, how would you rate your:

Physical Fitness

Mental Resilience

Leadership Skills

Overall Satisfaction With Life

Your Goals

What are the top 3 goals you want to achieve through mentorship?

Goal 1
Goal 2
Goal 3

What does success look like to you?

Do you have a specific timeline for achieving your goals?

Short Term (0-6 Months)

Medium Term (6-12 Months)

Long Term (12+ Months)

Your Strengths and Preferences

What do you believe are your greatest strengths?

How do you prefer to receive guidance and feedback?

Direct and to the point

Supportive and empathetic

Collaborative and conversational

Other

Please specify:

Do you have a preferred focus area for mentorship?

Please specify:

Your Lifestyle

How much time can you dedicate to mentorship sessions and related activities each week?

Less than 1 hour

1-3 hours

3-5 hours

5+ hours

Do you have any specific lifestyle habits or commitments that may impact your progress?

Are there any health or fitness considerations we should be aware of?

Previous Experiences

Have you worked with a mentor, coach, or trainer before?

Yes

No

What tools or resources have you used in the past to address your challenges?

Final Thoughts

Is there anything else you'd like us to know about you or your goals?

How committed are you to achieving your goals?

All-in: I’m ready to make significant changes.

Committed: I’m ready to put in effort but may need some support.

Exploring: I’m curious about mentorship but not sure what to expect.

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Self Assessment