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Preface

This is not a form. It’s a filter. These questions aren’t for everyone — they are for leaders who want to reflect, be challenged, and clarify how they actually pursue impact. Please answer truthfully.

Q1 — Impact vs. Profit

In times of crisis — COVID, a recession, or supply chain collapse — did you cut your own pay before reducing jobs or hours for employees? *YesNoN/A

If not, what would you do differently now? *

Q2 — Clarity of Cause

What is your cause, your purpose, your infinite pursuit? *

What have you already traded (or sacrificed) to pursue it? *

Q3 — Leadership Posture

A life-giving business improves the lives of its employees, customers, community, and its owner.

With this in mind, rate your business 1–5 on life-giving, with 5 being fully serving each of these groups. *

What holds you back from being a 5? *

Q4 — Risk & Patience

List your 1–2 biggest risk factors within your business. *

Are these risks aligned with your desired outcomes? *YesNo

Other than you as the owner, who is most exposed to these risks? *

Q5 — Capacity to Change & Learn

What’s the last thing you truly enjoyed learning, and why? *

How have you specifically applied that learning to how you lead? *

Q6 — Ego vs. Humility

When you think about the best leaders you’ve worked with, did they take more joy in giving credit or receiving it? *GivingReceiving

How does that compare to you? *

Q7 — Honesty & Transparency

On a scale of 1–10, how honestly did you answer these questions? *

What percentage of people do you think give themselves a 10? *0 / 4

Of those, how many do you think were actually 10/10 honest? *0 / 4

Do you believe you’re the exception? *YesNo

First Name *

Last Name *

Email Address *

Phone *

Company Name

Professional Identity *Business Owner, Founder, or CEOW2 looking to start a businessOther

Closing Reflection

If you found yourself leaning forward as you answered these questions, you might be an excellent fit for Modus.
If you hated this exercise, we may not be for you.

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