MyPALs Readiness Survey

MyPALs Readiness Assessment
This assessment will help you determine whether you would be a good fit for this system. We will fax you the results, so be sure to include your fax number along with the submission of this assessment. Unless you are specifically trained to do this work, someone who scores low is not a match for this process.
INSTRUCTIONS:
Below are a number of statements that refer to your goals, wants, and needs. Please rate the extent to which you agree or disagree with each of these statements. If you are confused by the wording of an item, have no opinion, or neither agree nor disagree, use the "0" or "NEUTRAL" rating.

	-3	STRONGLY DISAGREE
	-2	DISAGREE
	-1	SLIGHTLY DISAGREE
	-0	NEUTRAL
	1	SLIGHTLY AGREE
	2	AGREE
	3	STRONGLY AGREE


			-3	-2	-1	0	1	2	3
1.	I enjoy doing stuff on the computer with technology
2	I get as much enjoyment from making things happen as I do working
3.	My computer is state of the art
4.	I learn things quickly by doing them with my own hands
5.	I like having control of what I'm doing
6.	Once I learn something I enjoy the finer points of detail
7.	I enjoy writing as much as anything I do
8.	I don't mind making mistakes
9.	I like to work independently
10.	Getting things done is something I enjoy
			-3	-2	-1	0	1	2	3
11.	I comfortable with juggling many tasks at once
12	Once I get something down, I like to stick with it
13.	I'm not intimidated by technology
14.	I have extra time to put into learning this system
15.	I take a lot of pride in my work
16.	I like details and can follow instructions easily
17.	I have someone who I can go to when I'm stuck with my computer stuff
18.	I enjoy working on the Internet and by phone
19.	Getting someone to find me work and me doing it is great
20.	I can learn over the phone in front of my computer
21.	Building systems for people is something I would enjoy doing

Personal Information:

First Name:

Last Name:

Company Name:

Title/Position:

Address:

Suite:

City:

State:

Zip Code:

FAX: (required)

Email Address:

How did you hear about us?
If referred by a coach, please tell us their name.
Comments:
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