MasterMind Questionnaire

Please review the description of the MasterMind before filling in this form- thanks!

All information is kept confidential

(All Fields Are Required)

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

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?

Are you more Reserved or more Outgoing?
(1 = most reserved, 10 = most outgoing)

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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