Sample Women's Leadership Survey

- Instructions -

  • This survey must be completed by a person expressing their own attitudes regarding his or her Leadership Skills.

  • A response must be given the Identifying Information, all 10 questions and the Demographic Information that follows the questions.

  • At the end of the form be sure to click the 'submit' button.




 Identifying Information

For purposes of verifying your identity and collating your responses

please provide the following information about yourself:

First Name:
Last Name:
What is your Company?
What is your Employee e-mail address: 
Please enter your Employee ID (including leading zeros if any).  This ID will be used to identify you in order to provide feedback reports and analysis:

 

   

Very Strongly
Disagree

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Very Strongly
Agree

1.
To what extent do you feel the need to improve your leadership skills?

2.
To what extent do you feel the need to improve your long range planning skills?

3.
To what extent do you feel the need to improve your business acumen or business savvy?

4.
To what extent do you feel the need to improve your desire to achieve results?

5.
To what extent do you feel the need to improve your passion or commitment for achieving your goals?

6.
To what extent do you feel the need to improve your ability to collaborate effectively with all?

7.
To what extent do you feel the need to improve your work with external organizations or agencies?

8.
To what extent do you feel the need to improve your ability to size up people and potential talent?

9.
To what extent do you feel the need to improve your ability to confront underperformers?

10.
To what extent do you feel the need to improve your ability to handle rejection or set-backs?



Please enter any comments which you feel are relevant to your Leadership Skills!



Demographic Information

 

What is your Age?


 
Caucasian
Bi-racial
Hispanic, Latino/a
African-American
Asian or
Pacific Islander
American Indian or Native Alaskan
Multi-racial
Other
 specify below
Which of the following categories best describes your race or ethnicity?


Other Race:







FORM SUBMISSION

Thank you for taking the time to answer the questions in the self-assessment.

By clicking the SUBMIT FORM button your responses will be submitted for analysis.

 

To erase this form and start over.   Press the Clear Form button.  

Please Note: This will Delete Everything you have entered on this page.

Thank you for completing this assessment!!!

 

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