1. I often push myself to move away from the status quo or business as usual.

Strongly AgreeAgreeDisagreeStrongly Disagree

2. I regularly take stock of all my responsibilities, discerning which activities are critical and which are expendable, letting go those that no longer support a core function.

Strongly AgreeAgreeDisagreeStrongly Disagree

3. I understand the difference between management and leadership and value both skill sets in the workplace.

Strongly AgreeAgreeDisagreeStrongly Disagree

4. I am not afraid to raise unpopular positions in my workplace.

Strongly AgreeAgreeDisagreeStrongly Disagree

5. I occasionally pull myself away from the everyday tasks and routines to gain perspective on what is really going on and what direction we are taking.

Strongly AgreeAgreeDisagreeStrongly Disagree

6. I identify and act to close the gap that exists between the way I am living my life now and what I want to be doing.

Strongly AgreeAgreeDisagreeStrongly Disagree

Full Name:*

Email:*

Company:

Title:

By providing us your information, we will be adding you to our mailing list. We will not share you information with anyone else. And, you will have the opportunity to opt-out whenever you’d like.