GOAL SHEET

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Please make some time to sit with these questions. Please be honest and give each question real thought. This will help me to have a clear picture of where you are and where you want to be.

Name*

Age*

Grade / School*

Cell Phone*

Email Address

Home Address*

Why are you here?

Feel free to give examples to help me understand:

What are 3 strengths (mental and/or physical) you possess?

What are 3 areas of your life you would like to improve?

What are your favorite things to do (what makes you happy)?

What bothers you the most (tell me at least two things)?

What is the best way to motivate you?

If someone were to describe you, what would they say?

What are your immediate goals (next 3 months)?

What are any fears or resistances that stand in your way of achieving these goals?

How many close, strong relationships do you have at this point? Please list their names.

Tell me on a regular day what it is you eat from the time you wake up to the time you go to sleep:

How much water do you drink daily?

On average, how much sleep do you get each night?

How many hours a day are you on a screen (cell phone, video games, tablets, etc.)?

Are you someone who goes after what you want or are you a procrastinator who sometimes gives their best (feel free to explain in detail)?

Tell me about a time you felt accomplished (something your are proud of doing):

What are your long-term goals?

What are the obstacles that stop you from your dreams?

If you could change one thing about your life right now, what would it be?

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