MasterMind Questionnaire

All information is kept private and confidential

(All Fields Are Required)

Please indicate your readiness for change
(1 = not at all, 5 = "Let's Go...!")

In which group do you desire to be a member?

Any previous experience with a
Mastermind or similar-type group?

Are you ready to commit to showing
up to every meeting, for a 3-month period?
(Emergencies aside)

What MasterMind Goals do you have?

Everyone has a communication style they use most frequently. Knowing which style is the closest fit to your usual approach will help me to create a balanced group of members.

COMMUNICATION STYLES:
(As you read these simplified definitions, please be aware of which style pertains to you most.)

ANALYTICAL- Precise, Exact, Logical, Systematic, Task-oriented, Organized, Self-Reliant, Purposeful, and Diplomatic
Pace: Slow and Cautious

DIRECT- Decisive, Competitive, Independent, Confident, Focused, Results-Oriented, Ambitious, and Driven
Pace: Fast and Decisive

INITIATING- Sociable, Enthusiastic, Energetic, Spontaneous, Fun-Loving, Self-Assured, Innovative, and Persuasive
Pace: Fast

SUPPORTIVE- Calm, Steady, Approachable, Sincere, Careful, Patient, Gentle, Modest, Private
Pace: Slow and Patient

Which style most applies to you?

Are you ready to: learn from your peers, willing to ask for help, and willing to give as much as you receive?

And finally, are you willing to be supportive, and provide privacy and safety, when others share what truly matters to them?

Which Day(s) and Time Windows will work for you? (You may pick multiple days and windows). *Please be aware that the actual length of the meeting will be 60 or 90 minutes, depending upon group size.*
Sunday	Monday
Tuesday	Wednesday
Do you prefer to meet weekly or every-other week?

Is there anything else you'd like for me to know...?

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