Personal Profile Form

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Personal Profile Form

PLEASE NOTE that data entered on this form cannot be saved, and many of the questions will require some thought. If you prefer to save your information, you may open the form as a Word document and save it on your computer; then print and fax the completed form to (260) 489-9149 or email it to coaching@itgseminars.com.

Contact Information
Full Name:
Nickname:
Title:
Company Name:
Company Address:
City / State / Zip:
Phone 1:	Ext. Select Type:
Phone 2:	Ext. Select Type:
Fax:
Email:
Team Members
Team Member #1
Name:
Title:
Job Description:
Team Member #2
Name:
Title:
Job Description:
Team Member #3
Name:
Title:
Job Description:
Additional Team Members
Please List:
Industry Information
Date of Hire at Current Employer:
How long have you been working in the industry:
What do you like most about working for your current employer:
Production Information
Prior Year Production (in dollars):	$
Prior Year Production (in units):	#
What percentage was purchase:
What percentage was refinance:
If you currently track your production, what percentage comes from:
Real Estate Agents:
Builders/Contractors:
Sphere of Influence:
Past Clients:
Others:
Please list your referral sources and how many transactions you've closed with each in the past year:

Goals
What are your production goals for the next twelve months: What are your ultimate production goals (long term): What are your business goals for the next twelve months: What are your ultimate business goals: What are your personal goals for the next twelve months: What are your ultimate personal goals:
General Information
Define what being successful means to you: How do others see you now, both personally and professionally: How would you like for them to see you: What would you like to achieve through your personal coaching: When was the last time you spent your own money to attend training or continuing education related to your industry: What does a typical day look like for you (do you have any business and/or personal systems in place): Do you have a system for pipeline maintenance and review? If yes, please describe: How do you keep your clients informed of their status: Do you utilize a contact database system? If so, what system do you use and who on your team is responsible for maintaining the system: How often do you stay in touch with your contacts (current, previous and potential): What is preventing you from reaching your goals: Describe your ideal life picture for yourself:
Personal Information (Optional)
Marital Status:
Name of Spouse/Significant Other:
Birthday:
Anniversary:
Children:
Since we may not meet face-to-face, we would like to put a face with your name. If you have a photo of yourself, please upload it here: