2025 Executive Refresh Intake FormYour responses will help us tailor this retreat to best serve your needs. Please answer honestly and thoroughly. Personal Information Name * First Name Last Name Email * Phone * (###) ### #### LinkedIN URL What church are you a member of? Work and Routine What is your current job title? * Dropdown Option 1 Option 2 What are your responsibilities? (Amount of budget, Number of people you lead, impact on your organization?) What industry do you work in? How often are you on TEAMS or other virtual calls? Daily Weekly Occasionally What’s the most challenging part of your job? (if applicable) What is your primary stressor at work? (if applicable) How does your work align with your personal values or passions? What impact do you hope to have through your work? Leadership Experience How has your executive experience prepared you for this opportunity? What is the size of the largest team you have led or are currently leading? How has your leadership approach evolved as you've managed teams of different sizes? How would you describe your leadership philosophy? What is the largest dollar amount or budget you've been responsible for managing? How do you approach financial decision-making and resource allocation? Personal Background What do you consider your greatest strength, and how has it served you? What is something you’re currently proud of in your life? What’s a challenge you’ve recently overcome or are currently facing? Coaching and Development When was your last coaching session? Have you received formal coaching or mentoring? If so, please describe that experience and its impact in detail. What has been helpful in your coaching or development process? What planning tools are you currently using? How do you approach your own professional development? What skills or knowledge areas are you currently working to develop? What skills or knowledge areas are you looking to grow in? What attracts you to this particular opportunity? Health and Wellness Self-Assessment Please rate the following areas of your personal well-being. Spiritual health Strongly Disagree Disagree Neutral Agree Strongly Agree Relational health Strongly Disagree Disagree Neutral Agree Strongly Agree Friendships (not work-related) Strongly Disagree Disagree Neutral Agree Strongly Agree Enjoyment of personal hobbies Strongly Disagree Disagree Neutral Agree Strongly Agree Quality of rest/sleep Strongly Disagree Disagree Neutral Agree Strongly Agree Passion for life and work Strongly Disagree Disagree Neutral Agree Strongly Agree Work-life balance (work, family, friends) Strongly Disagree Disagree Neutral Agree Strongly Agree Physical health/fitness Strongly Disagree Disagree Neutral Agree Strongly Agree Eating habits/diet Strongly Disagree Disagree Neutral Agree Strongly Agree Fitness and Lifestyle Do you currently have a regular workout routine? Yes No If yes, please briefly describe. What type of physical activities or exercise do you enjoy? How do you typically unwind or relax after a long day? Life Transitions and Goals Have you experienced any significant transitions within the last 12 months (big or small)? Yes No If yes, please describe. What are your top three priorities in life right now? What do you hope to gain or achieve from this retreat? Relationships and Support Who is part of your personal support system, and how do they support you? How would you describe the role of friendships in your life? What does a healthy and fulfilling relationship look like to you? Self-Care and Growth How do you define self-care, and how often do you prioritize it? What motivates you to keep growing and improving? What is one area of personal growth you would like to focus on during this retreat? Vision and Aspirations How do you want your life to be different in a year? What do you want your life to look like in a year? Additional Notes Do you have any dietary restrictions or preferences we should know about? Is there anything else you’d like us to know to help make this retreat a success for you? Thank you!
