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Questionnaire template

Personal Growth Self-Assessment

A self-reflection on routines, habits and skills, growth areas and ranked development goals for coaching or personal planning.

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Questions in this template

Habits and Skills Today

  1. This reflection helps you take stock of where you are now and where you want to grow. It is a self-reflection exercise, not a test, so answer as honestly as you can.

  2. Do you stick to a regular daily routine?

    Choose one:

    • Yes
    • Somewhat
    • No

  3. How regularly do you do each of the following?

    • Eat a balanced diet
    • Exercise
    • Meet new people
    • Read books
    • Meditate

    For each row: choose one:

    • Regularly
    • Occasionally
    • Rarely or never

  4. How skilled would you say you are in each area?

    • Managing your time
    • Communicating clearly
    • Leading others
    • Solving problems

    For each row: choose one:

    • 1 - Not at all skilled
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10 - Highly skilled

Where You Want to Grow

  1. Which parts of your life would you most like to improve, and in what way?

    Open answer

  2. Which of these would you like to work on? Select all that apply.

    Choose any that apply:

    • Self-confidence
    • Networking
    • Managing stress
    • Public speaking
    • Setting goals
    • None of these

  3. Briefly, why did you pick these areas? (optional)

    Condition: Shown when at least one area was selected

    Open answer

  4. Order these goals by how much they matter to your development, from 1 (matters most) to 5 (matters least). Use each number once.

    • Advancing my career
    • Balancing work and personal life
    • Learning and education
    • Getting better with people
    • Living more healthily

    For each row: choose one from a list:

    • 1
    • 2
    • 3
    • 4
    • 5