GLOBAL WOMEN RESEARCH Response Form
The leading portal with your passport to success
U
Women in Focus™ International Virtual FORUM
# of Employees Working with You
Ethnic Background
Last Name
E-mail
Age Group
Country of Birth
Current Challenges You Face (Check all that apply)
Career Mobility
Finances
White
Business Start-Up
Relationships
White, non-Hispanic
Business Growth
Social Skills
African-American
Balancing Home and Work
Computer Skills
Hispanic
Single Mother
Spiritual Growth
Asian-Pacific Islander
Personal Motivation
Married
Native American
Health
Single
Other
Current Citizenship
City & State or Province Residing
Married or Single
Number of Children
Ages of the Children (if applicable)
In Transition
Other
If you checked OTHER, please explain here:
Where Do You Go For Support (Check all that apply)
Spouse
Pastor
Mother-Sibling-Family Member
Counselor
Friends
Boss
Co-Worker
Professional Organization
Coach
Other
If you checked OTHER, please explain here:
What Are the Top Ten Priorities in Your Life Right Now
In Your Opinion, What Resources Do Women Need the Most in Their Current Environments
Personal
Family
Work
Education
Community
List Your Industry of Work:
PROFESSIONAL BACKGROUND
We are interested in hearing from Women around the world such as you. Your identity when responding will be confidential. Please answer the questions below to help us get an indicator of what women want, to get to thenext level over the next three to five years. With your support, you can affect a network of services currently being
developed to help women propel their lives and businesses to the next level. Please be honest ... YOU CAN ALSO SUPPORT US BY FORWARDING THIS WEB PAGE TO OTHER WOMEN TO PARTICIPATE. Thank you.
Do You Own a Business
Yes
No
If you own a business, how many years?
Your Estimated (Business) Annual Revenue
Under $50,000
$251,000 - $500,000
$50,000 - $100,000
$501,000 - $1,000,000
$101,000 - $250,000
Over $100,000,000
$5,001,000 - $25,000,000
$25,001,000 - $100,000,000
$1,001,000 - $5,000,000
OTHER INFORMATION
Highest Educational Level COMPLETED
Less than high school
4-Year Degree -- Bachelors
High School -- GED
Masters Degree
2-Year Degree -- Associates
Doctoral Degree
Professional Degree -- MD or JD
Your Personal Income
Under $30,000
$101,000 - $150,000
$51,000 - $75,000
$151,000 - $250,000
$76,000 - $100,000
Over $1,000,000
$501,000 - $1,000,000
$30,000 - $50,000
$251,000 - $500,000
Your Household Income
Would you like to receive the results of this survey and other updates and resources for women from us?
Yes
No
THANK YOU FOR YOUR TIME AND INPUT.

©2005 Women in Focus™ FORUM; CCTT, LLC; Jonnetta Chambers, M.A.; All Rights Reserved

WIFF RESEARCH | ©2005 Women in Focus™ FORUM;

CCTT, LLC; Jonnetta Chambers, M.A.; All Rights Reserved
Estimated (Company) Annual Revenue
Under $50,000
$251,000 - $500,000
$50,000 - $100,000
$501,000 - $1,000,000
$101,000 - $250,000
Over $100,000,000
$5,001,000 - $25,000,000
$25,001,000 - $100,000,000
$1,001,000 - $5,000,000
Under $30,000
$101,000 - $150,000
$51,000 - $75,000
$151,000 - $250,000
$76,000 - $100,000
Over $1,000,000
$501,000 - $1,000,000
$30,000 - $50,000
$251,000 - $500,000