Fan into Flame WeekendLife Satisfaction Questionnaire Please complete the form below in order to get you thinking about yourself prior to the weekend and to give staff a “snapshot” of where you are today Name * First Name Last Name What are the most important things, good and bad, happening in your life right now? * How would you like your life to be different one year from now? * What is getting in the way of this change? * Describe your spirituality. What is your relationship with God? Do you sense God might be challenging you or nudging you to make a change? * List three things you have been putting off * How might you sabotage your growth experience this weekend? * What, if any, are your concerns about this weekend? * What do you hope to gain while here? * Is there anything else I need to know before the weekend? * Life Satisfaction Survey How satisfied are you with different areas of your life? Select a number from 1 to 10 for each of the following areas. This may change from day to day, but try to give me an overall assessment of where you are most of the time. 1= completely dissatisfied 10=I could not be happier or more satisfied. Physical Health * 1 2 3 4 5 6 7 8 9 10 Mental/Emotional Health * 1 2 3 4 5 6 7 8 9 10 Career/Employment * 1 2 3 4 5 6 7 8 9 10 Financial * 1 2 3 4 5 6 7 8 9 10 Marriage or Romantic Relationship * 1 2 3 4 5 6 7 8 9 10 Immediate Family * 1 2 3 4 5 6 7 8 9 10 Extended Family * 1 2 3 4 5 6 7 8 9 10 Friends and Social Life * 1 2 3 4 5 6 7 8 9 10 Recreation, Relaxation or Leisure * 1 2 3 4 5 6 7 8 9 10 Work-Life Balance * 1 2 3 4 5 6 7 8 9 10 Personal Life Fulfillment * 1 2 3 4 5 6 7 8 9 10 Spiritual Health * 1 2 3 4 5 6 7 8 9 10 Church or Religious Life * 1 2 3 4 5 6 7 8 9 10 Comfortable home * 1 2 3 4 5 6 7 8 9 10 Thank you!
