Pre-Course Survey | Strozzi Institute: Embodied Leadership

Please take a few minutes to complete the pre-course survey.

Please Note: After submitting the questionnaire, we will email you your answers for your records. However, if you feel strongly about keeping a record of your answers, it is suggested that you prepare/store your answers in a separate document prior to submission

How true are the following statements?

Which of these represents why you are taking this course? *

Select all that apply

Self Transformation/Growth

Leadership Development

Professional Development

Interpersonal/Teamwork Development

Develop Bodywork/Healing Skills

Current Coaching Status

Only for students of our Somatic Coaching Certification Program

Corporate/Business Coaching

Please answer the following questions

How would you like your name to appear on your name badge?

Describe your current personal goals. (i.e., relationships, family, leisure time):

Describe your current professional goals. (i.e., Job, career, income, contribution):

Under pressure, what ways do you respond that are effective, and what ways do you respond that are not effective?

What do you hope this course can offer you?

List known allergies:

List medications you are taking for physical or psychological conditions:

List any injuries we should be aware of:

Dietary Preference (Select all that apply):

Emergency Contact Relationship

Emergency Contact Phone