assessment

Program Assessment Form

This form will help me get to know you and your business a little better, and to see if I am able to support you.

All answers are held in the strictest confidence and will not be shared with anyone outside of my company. Ever!

Name

First Name

Last Name

Business Name

Email Address

Describe your business: Who do you help & what are the primary benefits you deliver for your clients and customers?

Your Business URLs: Feel free to include blogs, Facebook Fan pages, YouTube Channels and product pages (if you have them).

Your total annual income

Percentage of you total income you make from the business we will be working on

[example answer: 45% of my total income comes from the business we will be working on]

Size of your email list

[example answer: 800 names]

The 3 most important goals that would make the biggest different in your business over the next 180 days. For each goal, write down - in dollars and in emotional payoff- what accomplishing the goal would be worth to you.

The 2 most important business goals that you would like to accomplish in the next year. For each goal, also write down - in dollars and in emotional payoff- what accomplishing that goal would be worth to you.

On a scale of 1 to 10, what is your level of commitment to achieving these business goals in the next year? (with 10 being "extremely committed" and 1 being "not very committed."

Rob Fortier

Email Marketing, List Management and Copywriting

Create a business you love EXACTLY the way you want it.