The Questions

ALTA Intake Questionnaire

Step 1 of 7

Your Personal Information
Name*
First Last
Email*
Phone*
City*
State/Province/Region*
Country*
Date of Birth*
Date Format: MM slash DD slash YYYY
Level of Education*
Gender
Marital Status*
What challenges or issues might you like to resolve in your personal or business life?*

Answering Instructions:
It is NOT required that you answer ALL of the following Education Questions. You have four answering options: 1. Leave it blank and unanswered, 2. Mark it as Excelled, 3. Mark it as Enjoyed, or 4. Mark it as Struggled.
Educational Subjects of Interest: English
Please mark the following list of High School or College English classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply skip them and leave blank.
Literature
Poetry
Journalism
Creative Writing
Educational Subjects of Interest: The Sciences
Please mark the following list of High School or College Science classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply skip them and leave blank.
Biology
Chemistry
Physics
Geology
Technology
Educational Subjects of Interest: Business
Please mark the following list of High School or College Business classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply skip them and leave blank.
Business Law
Economics
Educational Subjects of Interest: Mathematics
Please mark the following list of High School or College Math classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply leave blank.
General Math
Business Math
Algebra
Geometry
Calculus/Trigonometry
Educational Subjects of Interest: The Arts
Please mark the following list of High School or College Artistic classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply leave blank.
Drawing/Sketching
Sculpting
Painting
Photography
Design: Graphic/Web
Music
Dance
Drama
Educational Subjects of Interest: Social Studies
Please mark the following list of High School or College Social Study classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply leave blank.
Government/Politics
Geography
History
Psycology
Sociology
Anthropology
Foriegn Language
Educational Subjects of Interest: The Trades
Please mark the following list of High School or College Vocational classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply leave blank.
Automotive
Carpentry/Woodworking
Metal Working
Electrical
Computer Repair
Drafting/Architecture
Educational Subjects of Interest: Physical Education / Sports
Please mark the following list of High School or College P.E. classes as: Struggled, Enjoyed, or Excelled. On those that don't apply simply leave blank.
Gymnastics
Martial Arts
Field Sports
Swimming

Occupation / Career Questions
Describe the activities of your current occupation. (If currently unemployed please state your prior occupation.)*
Are your EXPECTATIONS being met by this occupation? Why or why not?*
What do you feel is IMPORTANT about your occupation?*
What gives your occupation MEANING and why?*
What do you do to ESCAPE mentally from your daily occupational activities?*
While interacting professionally with your customers you prefer to either: A) Establish quality relationships somewhat like a counselor with a client or B) Connect with others usefully in the moment and no deeper.*

Three Events of Well-being
Name three specific moments in your adult life that gave you a feeling of either happiness, satisfaction, well being or contentment.
Happy Event 1*
Describe why it was satisfying for you.*
Happy Event 2*
Describe why it was so fulfilling for you.*
Happy Event 3*
Describe why it made you happy.*

8. Three Frustrating Events
Name three specific events in your adult life that made you angry, frustrated, extremely irritated or otherwise greatly dissatisfied.
Frustrating Event 1*
Why did you find this event so disatisfying?*
Frustrating Event 2*
Why did you find this event so frustrating?*
Frustrating Event 3*
Why did this event anger you?*

What make, model and year is the car that you drive? If you own two or more state your favorite?*
Explain why you bought that particular kind of automobile?*
When you make purchases for YOURSELF ONLY you tend to be:*

Describe what you do to relax?*
Describe a hobby of yours.*
Name
This field is for validation purposes and should be left unchanged.

ALTA Intake Questionnaire

Step 1 of 7

Your Personal Information

Answering Instructions:

Educational Subjects of Interest: English

Educational Subjects of Interest: The Sciences

Educational Subjects of Interest: Business

Educational Subjects of Interest: Mathematics

Educational Subjects of Interest: The Arts

Educational Subjects of Interest: Social Studies

Educational Subjects of Interest: The Trades

Educational Subjects of Interest: Physical Education / Sports

Occupation / Career Questions

Three Events of Well-being

8. Three Frustrating Events