Name *

First Name

Last Name

Phone *

(###)

###

####

Age *

25-35

36-45

46-55

56-65

65 and Over

Are You Employed? *

Yes

No

Relationship Status *

Single

Married

Divorced

In Relationship

Trying To Figure It Out

Do you have children? *

Yes

No

Maybe

In 2020 what had more impact? *

The Death of Kobe

The Pandemic

Racial Injustice

As a man do you invest in yourself? *

Yes

No

How do you invest in yourself? *

Books

Spiritual Development

School

Real Estate

Business

Do you have other men that hold you accountable to your dreams? *

Yes

No

Would you invest in therapy, life coaching or any accountability group for men? *

Yes

No

Where do you buy groceries? *

Shop Rite/Safe Way/Krogers/Publix

Costco/Sam's Club/ BJ's

Walmart

Online Meal Prep

Whole Foods/ Trader Joe's

What's your favorite downtime time activity? *

Playing a sport/working out

Reading

Video Games

Listening Music

Social Media

Watching TV

How much time on weekly basis, do you invest yourself? *

This could be exercise, reading, listening to educational podcast, spiritual development & talking to a health professional.

1-7 hours a week

7-14 hours per week

14-21 hours per week

What's best way you consume information? *

Reading

Listening to Audiobooks/Podcast

Watching Youtube Videos

Working with Someone

DIY (Doing It Yourself)

How much of a financial investment within a month would you invest in personal development? *

$0-$50

$50-$100

$100 & Over