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Fulfilling Lives Survey

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.

Part I - PERSONAL INFORMATION:

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:
Under 18   41-49
19-25   50-59
26-30   60-69
31-40   70+
7. Gender:
Male   Female
8. Relationship Status:
(check all that apply)
Married - How many years?
Single
Widowed
Divorced
Significant Other (1+ year) - How many years?
Boyfriend/Girlfriend (less than 1 year)
Dating - no one special
Living with Partner or Spouse
Not Dating
9. Career / Profession:
Business Owner/Entrepreneur   Part-Time
Professional Services   Technical/Computer/Engineer
Government   Stay at Home Mom or Dad
Sales   Network Marketing
Marketing/Advertising   Healthcare
Corporate   Retired
Administrative   Entertainment
Executive/CEO   Home Based Business
Investor   Coaching
Student   Unemployed
Blue Collar Laborer   Other:
Education      
10. Spiritual Orientation:
How would you describe your current spiritual orientation?
Spiritual - RELIGIOUS
SPIRITUAL - NOT Religious
NOT Spiritual and NOT Religious
What other descriptions apply to you?
(check all that apply)
Belief in Higher Power   Christian
Belief in Your Personal Power   Jewish
Belief that the Answers are Within You   New Age
You are in control of your Life and Destiny   Catholic
God is in control of your Life and Destiny   Buddism
We are all Universally Connected   Taoist
We are Spiritual Beings Having a   Islamic
  Human Experience   Hindu
God-Fearing - Christian   Atheist
Non-denominational - Christian   Searching
Don't know what I really believe spiritually   Other:
11. Personal Growth Factors:
Select the activities that have supported you in furthering
your personal growth and development.
(check all that apply)
Reading Books   Body Work
Counseling / Therapy   Support Groups
Meditating   Addiction Treatment
Journaling   Spiritual Healers
Seminars/Workshops   Self-Reflection/Personal Awareness
Audio Tapes   Meaningful Conversations
Teleclasses   Other:
Attending Church   None of the above
Personal Coaching      
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      

Part II - Fulfilling Lives Survey

1. Select the 5 Groups of ACTIVITIES that are very fulfilling to you.
TV/Movies
Fitness/Exercise/Sports
Time w/Loved Ones or Friends
Seminars/Workshops/Teleclasses
Reading
Learning/Growing
Meditating/Self-Reflection/Journaling
Live Entertainment
  (plays, concerts)
Traveling/Exploring
Making Love/Intimacy/Sex
Time in Nature/Sunsets
Relaxing/Napping/Doing Nothing
Accomplishment
  (tasks, projects, etc.)
Meaningful Conversations/Connecting
 
Special Interests/Hobbies
  (sports, crafts, music, cooking, boating,
gardening, shopping, hunting, fishing, etc.)
Creative Self-Expression
  (perform, act, comedy, singing/writing,
projects, art)
Community Activities
  (church, clubs)
Making a Difference, Teaching,
  Contribution/Volunteering,
  Service Projects
Pampering Self
  (massage, facial, manicure, bubble
baths, etc.)
Savoring Fine Foods/Wine
Anything New/Exciting
Other:
   
2. Which of these Emotions do you experience WEEKLY?
(check as many as apply)
Joy/Happiness   Anger
Love   Fear
Connection   Overwhelm
Accomplishment   Stuck
Playful   Frustration
Gratitude   Sadness
Abundance   Depression
Excited/Enthusiastic   Hate
Celebration   Jealousy
Creativity/Self Expression   Self-Pity
Growing   Worry
Compassion   Resentment
Relaxed/Peaceful   Pissed-off/Irritated
Giving/Contribution   Judging (self or others)
Energized/Vitality   Drained/Lethargic
Freedom   None of the Above
      Other:
3. What % of your TIME do you spend focusing on...
The Past:
The Present:
The Future
Total = 100%
4. Which of the THREE areas below AFFECT or influence your fulfillment the MOST?
Health & Fitness   Personal Growth
Emotional Health   Family
Career & Work   Home/Office Environment
Spirituality   Fun - Recreation - Adventure
Finances & Money   Significant Other Relationship
Friends - Social Life   Other:
5. What personal QUALITIES, characteristics and/or personality traits within yourself help you create Fulfillment in your life?
(check ALL that apply)
Natural Tendency to be Happy   Easily Let Go of Negativity
Positive Attitude   Willingness to "do what it takes"
Self-Awareness   Discipline
Remembering to be Fulfilled   Passion for Life
Changing Focus   Abundance Mentality
Desire to be Fulfilled   Other:
Spiritual Connection      
6. What "Gets in the Way" of your Personal Fulfillment?
Time   Lack of Focus
Energy level   Laziness or Lack of Discipline
Other People   Irresponsible
Job or Career   Unclear of Wants/Desires
Attitude   Time Management
Internal dialogue   Myself
Fear   Nothing
Don't Know   Other:
Stress/Overwhelm      
7. What would make your life even MORE fulfilling?
(select 1 - 5)
Identify Purpose   Meaningfulness in Life
Live Purpose More Fully   Making Love, Sex, Intimacy
Live Values More Fully   Supportive Friends/Community
Increase Income   Fun, Excitement and Adventure
Simplify my Life   Slow Down/Relax/Nurture Self
Eliminate Tolerations   Find Soulmate/Partner
Improve Relationships   Greater Self-Expression
Communication Skills   Enhance Home/Surroundings
Greater Net Worth/Savings   Greater Discipline
Career Change   Gratitude
Live Fully in Present Moment   Greater Self Appreciation
Greater Control of My Life   Knowledge/Learning/Growth
Clarity/Prioritization   Professional Support (i.e. coach)
Achievements/Accomplishments   More Free Time
Have Children/Family   Other:

Part III - Fulfilling Lives Survey

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 1 2 3 4 5 6 7 8 9 10 Agree
2. I easily delight in the littlest things; and in creating "magical moments".
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
4. I am pleased and satisfied with my overall level of health and fitness.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
5. I have more than enough energy and vitality to get me through the day, and to create the life I want.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
6. My work/Career is both fulfilling and nourishing to me; I am energized.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
7. I am both pleased and content with my spouse/partner, or happy being single.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
8. I spend the right amount of fun, excitement, recreation and adventure in my life. I spend my leisure time enjoying my interests.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
9. My home and office environments support and enhance my fulfillment; my surroundings nurture my soul.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
10. I know myself well: my needs, wants, values, goals and dreams. I am clear about what contributes to my sense of fulfillment.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
14. I love myself fully, and feel I deserve a fulfilling life.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
15. My life is free of unnecessary clutter and complexities; I seldom feel overwhelmed, rushed or cluttered.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
16. The five to ten people I associate with most support, encourage and contribute to my highest potential and highest level of fulfillment.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
17. I spend time consistently to nurture, develop and strengthen the connections with my family, friends, and community.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
18. I have a rich and satisfying spiritual life.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
19. I TRUST that God (or The Universe or Higher Self) supports me in living a fulfilled life.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
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 1 2 3 4 5 6 7 8 9 10 Agree
22. I am living a fulfilling life.
Disagree 1 2 3 4 5 6 7 8 9 10 Agree

Part IV - Follow UP:

1. I would like to receive your FREE Newsletter, "SoulFULLY Living"
2. I would like to sign up to receive Your Daily Gems.

THANK YOU so much for completing the Fulfilling Lives Survey. Your input is invaluable to us. We hope you found the survey enlightening and useful to you, as most of our visitors have. We're one step closer to achieving our goal of 100,000 survey participants. Thank you! Press the submit button to immediately receive a Fulfillment Score and suggestions about how to improve it. You'll also receive another complimentary Quality of Life Assessment to further support you. By pressing the submit button you also agree to allow Life Coach Mary to use this information in upcoming books. We invite you to share this survey with others by referring them to www.fulfillinglives.com/survey.php to participate in the survey.

Playfully and Joyfully,

The PlayTeam at FullfillingLives.com


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