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God Confidence Survey
Name
*
First
Last
Email
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On a scale of 1-10 how would you rate your confidence?
1 (Low)
2
3
4
5 (Average)
6
7
8
9
10 (High)
Confidence
Confidence 1 (Low)
Confidence 2
Confidence 3
Confidence 4
Confidence 5 (Average)
Confidence 6
Confidence 7
Confidence 8
Confidence 9
Confidence 10 (High)
Which area of your life do you most lack confidence in? (Check all that apply)
Social
Work
Home
Personal/Relationships
Public Speaking
Self Image/Relationship with Yourself
Are there other specific situations? (Please be specific.)
What single thing or situation causes you the most anxiety due to lack of confidence?
How would having greater confidence make your life better?
How do you like to learn? (Select Top 2 Categories)
Reading: Physical books; Ebooks; PDF;
Listening: Downloadable audio;mp3’s or audio cd
Watching: Online videos, Masterclasses, DVDs
Teleseminars, Conference Calls
Where do you currently get advice/guidance about self-confidence?
Books
Websites
Workshops
Social Media
Friends/Family
Professional (i.e. Doctor, Therapist)
Other (Please be specific)
What do you feel is missing from other sources of advice/guidance that would help build better self-confidence?
What do you hope to gain by taking this journey?
Message
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