Company Name *

Company Website *

Business & Leadership

What was your company’s revenue last year? *

How many employees and contractors do you have? *

What percentage of the company do you personally own? *

What is your core business? Describe what you do/offer/sell. *

What is your role in the company? How would you describe your leadership style? *

Challenges & Vision

What are your most pressing 1-3 challenges? (In your business, leadership, life, etc.) *

Where do you want your revenue to be 12 months from now? *

What is your biggest vision for your company? What do you truly want that feels "impossible"? *

Imagine your next decade is your best one yet. What is your wildest dream? *

What is the gap between that and where you are right now?

Next Steps

On a scale of 1-10 (with 10 the highest), how ready and motivated are you to make meaningful change in your business and life? Please explain. *

Where could you get tripped up? *

What leadership development, coaching, and/or consulting have you invested in the last 3 years? What worked and what didn't?

How did you hear about a Rise Up Session with Nadine & Derek Nicholson at Ascend Leadership Co.? *

Conference – Met someone from Ascend in person

Speaking Event – Heard Nadine and/or Derek speak at a conference, podcast or other event

Impossible Freedom Quiz – I heard about this after taking Ascend's quiz

Other – (Please specify)

What else do you want us to know about you before we meet?

Contact Information

First Name *

Last Name *

Title

City

State/Province *

Email *

Cell Phone *

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