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THE GREAT COMMUNICATOR PROGRAM FOR CEOs ™ GOAL SETTER QUESTIONNAIRE

This questionnaire is designed to help us prepare The Great Communicator Program for CEOs ™specifically
suited to your needs. Please take a few minutes to fully answer all the questions. Thank you for your assistance.
FIRST NAME LAST NAME PREFERRED LAST NAME
TEAM POSITION/TITLE ZIP CODE
ADDRESS EMAIL DATE OF BIRTH
(mm/dd/yyyy)
CITY STATE  
PHONE FAX
CELL ASSISTANT
SCHOOLS ATTENDED: DEGREES RECEIVED:
PROFESSIONAL ASSOCIATIONS: CLUBS, CIVIC, PHILANTHROPIC ORGANIZATIONS:
PREVIOUS PUBLIC SPEAKING/PRESENTATION SKILL TRAINING:

DO YOU GIVE SPEECHES REGULARLY?
YES NO IF YES, BRIEFLY DESCRIBE:

WHAT ARE YOUR MOST IMPORTANT OBJECTIVES FOR ENROLLING IN
THE GREAT COMMUNICATOR PROGRAM FOR CEOs?		 WHAT DO YOU CONSIDER YOUR STRONGEST COMMUNICATION SKILLS?
WHAT PRESENTATION SKILLS ARE MOST IN NEED OF IMPROVEMENT? .PLEASE ATTACH YOUR CURRENT BIO:
PLEASE LIST YOUR TOP 6 CLIENTS RANKED BY ORDER OF IMPORTANCE: PLEASE LIST YOUR TOP 6 COMPETITORS RANKED BY ORDER OF IMPORTANCE:
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