Thank you for taking the time to complete this survey!!! Your participation will contribute directly to a new book being written about "creating and living fulfilling lives". All information received by you through this survey will remain anonymous. Answer each question as "authentically" as possible, without dwelling on any one question. Go with your initial response. Enjoy the process of taking this survey. For most, it is an enlightening experience. Again, huge "Thank You's" for your participation!!! We appreciate your support.
1.
Name:
2.
Address:
3.
City, State and Zip:
4.
Email Address:
5.
Where did you hear about FulfillingLives.com?
(Please include email address of your referral source so they get credit for the drawing.)
6.
Age:
7.
Gender:
8.
Relationship Status:
(check all that apply)
9.
Career / Profession:
10.
Spiritual Orientation:
How would you describe your current spiritual orientation?
What other descriptions apply to you?(check all that apply)
11.
Personal Growth Factors:
Select the activities that have supported you in furthering
(check all that apply)
12.
Financial INCOME:
(optional)
Less than $15,000
$60,000 - 75,000
$15,000 - 25,000
$75,000 - 100,000
$25,000 - 35,000
$100,000 - $250,000
$35,000 - 45,000
$250,000+
$45,000 - 60,000
1.
Select the 5 Groups of ACTIVITIES that are very fulfilling to you.
Special Interests/Hobbies
(sports, crafts, music, cooking, boating,
Creative Self-Expression
(perform, act, comedy, singing/writing,
Community Activities
(church, clubs)
Making a Difference, Teaching,
Contribution/Volunteering,
Service Projects
Pampering Self
(massage, facial, manicure, bubble
Savoring Fine Foods/Wine
Anything New/Exciting
Other:
2.
Which of these Emotions do you experience WEEKLY?
(check as many as apply)
3.
What % of your TIME do you spend focusing on...
4.
Which of the THREE areas below AFFECT or influence your fulfillment the MOST?
5.
What personal QUALITIES, characteristics and/or personality traits within yourself help you create Fulfillment in your life?
(check ALL that apply)
6.
What "Gets in the Way" of your Personal Fulfillment?
7.
What would make your life even MORE fulfilling?
(select 1 - 5)
Instructions: Click on the button to the left of the number which best represents your answer. Use "5" as neutral or lacks clarity; above 5 is working above average or is clear. Go with your first answer, try not to overanalyze any one question.
1.
I consistently spend time, reflection and thought on enhancing the level of fulfillment in my life. Living a fulfilled life is important to me.
Disagree
2.
I easily delight in the littlest things; and in creating "magical moments".
Disagree
3.
I take time regularly to nurture myself in ways that feed my soul (i.e. meditate, reading, taking a bath, exercise, or other)
Disagree
4.
I am pleased and satisfied with my overall level of health and fitness.
Disagree
5.
I have more than enough energy and vitality to get me through the day, and to create the life I want.
Disagree
6.
My work/Career is both fulfilling and nourishing to me; I am energized.
Disagree
7.
I am both pleased and content with my spouse/partner, or happy being single.
Disagree
8.
I spend the right amount of fun, excitement, recreation and adventure in my life. I spend my leisure time enjoying my interests.
Disagree
9.
My home and office environments support and enhance my fulfillment; my surroundings nurture my soul.
Disagree
10.
I know myself well: my needs, wants, values, goals and dreams. I am clear about what contributes to my sense of fulfillment.
Disagree
11.
I am comfortable in fully expressing myself and "being authentically me". I truly don't care about other's opinions of me. I am confidant in who I am. I say what I feel, and I do so responsibly.
Disagree
12.
My life is oriented around my values and what's important to me. My life is shaped by me rather than by what others expect of me or think I should be. I am eagerly making the life I desire a reality.
Disagree
13.
I am satisfied with my current financial status - income and savings. I feel good about my relationship with money and how I use it to serve me. I feel financially secure and/or am "on track" in becoming financially secure.
Disagree
14.
I love myself fully, and feel I deserve a fulfilling life.
Disagree
15.
My life is free of unnecessary clutter and complexities; I seldom feel overwhelmed, rushed or cluttered.
Disagree
16.
The five to ten people I associate with most support, encourage and contribute to my highest potential and highest level of fulfillment.
Disagree
17.
I spend time consistently to nurture, develop and strengthen the connections with my family, friends, and community.
Disagree
18.
I have a rich and satisfying spiritual life.
Disagree
19.
I TRUST that God (or The Universe or Higher Self) supports me in living a fulfilled life.
Disagree
20.
I enjoy living in the present moment. I easily let go of distractions, worries, and stress from the past or about the future.
Disagree
21.
My life is balanced; I spend time and attention developing several areas of my life. My life is multi-dimensional - and in harmony.
Disagree
22.
I am living a fulfilling life.
Disagree
