ActionVision for Children/Youth

IMPORTANT NOTE: Students, please obtain parent's permission prior to proceeding.

Interview Date: ____/____/_____

Name: ____________________________

Organization: ____________________________

Home Phone: (______)________-____________

Pager: (______)________-____________

E-Mail: _________________________________

Interviewer: ________________ ID_________
Please attach interviewer and interviewee's business card.

Home Address: _______________________________ Home Phone: (____)_____-______

City: _________________ State: ___ Zip: __________ Fax Number: (____)_____-______

Name of Parent(s): ________________________________________________________

Parent's Employer: _____________________________ Position: _____________________

Business Address: _____________________________ Phone: (____)_____-______

City: _________________ State: ___ Zip: __________ _Fax Number: (____)_____-______

E-mail address: ______________________

Life Masteries Use Only: Computer Plan Developer: _______________ Client Would Like Completed By: _/__/___
Interview scheduled: ___/___/____, Interview Completed: ___/___/____, Submitted: ___/___/____,
1st Draft Completed: ___/___/____, Final Plan Completed: ___/___/____.

[ ]-Menu Worksheet [ ]-Free Form (see form at end of menu), / [ ]-Basic [ ]-Advanced / [ ]-Workshop / Complexity Level: ___

ActionVision Interviewer: ________________ ID_________

Monthly reviewer: ________________ ID_________

Certified Level 3 individual: ________________ ID_________

Life Masteries, Inc. - Menu Worksheet

The following are the most important steps in developing your own personal twelve month life plan. Do not worry about doing everything perfectly. The best way to learn is to "jump right in" and do the best you can. As you gain experience you will learn how to modify your plan. We have recommended a minimum amount of time to invest into each step. You may take additional time but it usually is not needed.

1. What are some of the ingredients to your personal vision statement? (7 minutes)
(How do you want others to think of you?)
(If you are not sure just write some key words that you would like to be known for.)

2. Please list three to five specific measurable actions you would like to improve over the next 12 months. These could represent any area of your life: personal, career, spiritual, or family.
1.
2.
3.
4.
5.

3. By having three to four individuals assist you in following up on your personal plan, we have found that the likelihood of you following through on the plan will increase. If an individual tries to do it on their own, we have found 45% or less will follow through. If an individual works with someone certified by Life Masteries Institute, Inc., as well as several other peers, we have seen 95% of them follow through with their actions.

Who would you like to have assist you with following through on your actions? It is ideal to have one of each personality type assist you. See the personality section for additional information.
(Note: Teenagers often are the most effective individuals to help you follow through.)

1. ____________________________ (Certified in ActionVision by Life Masteries Institute)

2. ____________________________

3. ____________________________

4. ____________________________

4. What would you like at the top of your ActionVision plan?

A. Percentage of plan you are currently doing: ____% Would like to get to: ____%
(You may complete this after you have selected all your actions.)

B. Personality type. (primary)___________ / (secondary)____________
[Analytical, Driver, Expressive, Amiable]

C. Percentage of focus. [ ]-Yes, [ ]-No.

D. People to influence over next twelve months.

1. ____________________

2. ____________________

3. ____________________

4. ____________________

E. Personal talents to share with others over next twelve months.
(List your top four strengths that you would like to use helping others.)

1. ____________________

2. ____________________

3. ____________________

4. ____________________

F. Please list other items / information you would like at the top of your plan. Please try to be as clear as possible.

5. Let's work together to create a budget for our actions. (This is a three part process.)
Part A: Please list three to five of the most important areas of your life?
(Example: dreams/goals, relationships, education, personal development, spiritual walk, work)

Part B: If you had 100 points (percent) to divide into those areas, where would you place those points? (This is a combination of time and focus.)
(Example: dreams-15%, relationships-20%, education-25%, personal-25%, spiritual-15%)

Part C: Multiply each percent by 20 to determine the number of actions for each major area.
(Example: dreams=15%; 0.15 x 20 =3, relationships-4, educational-5, personal-5, spiritual-3)
Number of Actions based on percentages:
5% = 1 20% = 4 35% = 7 50% = 10
10% = 2 25% = 5 40% = 8 55% = 11
15% = 3 30% = 6 45% = 9 60% = 12

Part A Part B Part C

Five Major Areas % of time & focus Number of actions

1) Dream/goals (15%)___________________% (3)___________________

2) Relationships (20%)___________________% (4)___________________

3) Education (25%)___________________% (5)___________________

4) Personal Development (25%)___________________% (5)___________________

5) Spiritual (15%)___________________% (3)___________________

Note: If you are uncertain, feel free to use the example which is in parentheses and italics. In many situations this is recommended for the first year on ActionVision.

Important Note
The following pages include "action menus." They help us to develop specific actions for our personal life plan. When selecting from the menus, there may be actions you : do currently and would like to continue; want to do but haven't done in the past; do currently but you would like to do more often or more effectively; or stopped doing, but want to restart them.

It is important to remember you have a "budgeted" number of actions for each area of your life. If you choose too many actions in one area, it will lower the number of actions that you assign to another area of your life. All ActionVision plans have a total of twenty actions. You will do much more than twenty, but this system will help you measure the twenty most important actions for your life. There are a million good things that you could do, we want to help you focus on the twenty great things in your life.

To assist in choosing the best actions, some of the most popular actions have been bolded for your consideration.

Actions For Your Personal Plan

Please write the action code from the ActionVision menus and then quantify those actions. Actions may be quantified based on number of activities (example: 1/mo, 10/wk, 5ea/mo), or based on time (1hr/mo, 30min/ea, 5hrs/wk, 1day/wk). Please keep "quantified" entry to 10 characters or less. The more carefully you define and quantify your actions, the better the system will work. If you would like to edit an action, please clearly write what you would like the action to say.

Code Quantified Action or further enhancement of action

1 ________ __________ ________________________________________________________

2 ________ __________ ________________________________________________________

3 ________ __________ ________________________________________________________

4 ________ __________ ________________________________________________________

5 ________ __________ ________________________________________________________

6 ________ __________ ________________________________________________________

7 ________ __________ ________________________________________________________

8 ________ __________ ________________________________________________________

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10 ________ __________ ________________________________________________________

11 ________ __________ ________________________________________________________

12 ________ __________ ________________________________________________________

13 ________ __________ ________________________________________________________

14 ________ __________ ________________________________________________________

15 ________ __________ ________________________________________________________

16 ________ __________ ________________________________________________________

17 ________ __________ ________________________________________________________

18 ________ __________ ________________________________________________________

19 ________ __________ ________________________________________________________

20 ________ __________ ________________________________________________________

21 ________ __________ ________________________________________________________

22 ________ __________ ________________________________________________________

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25 ________ __________ ________________________________________________________

Student Life Management—ActionVision Menu
Dreams & Goals

SM1 Dreams and Goals
SM2 Relationships
SM3 Education
SM4 Personal Development
Number of actions in this section.

(3) #
SM5 Spiritual Growth

SM1 Dreams and Goals
SM1a-a Set short-term goals and review weekly.
SM1a-b Work with parents toward achieving personal goals.
SM1a-c Develop and follow short/long-term written goals.
SM1a-d Work with highly motivated individual(s) to help reach goals.
SM1a-e Develop long-term goals and determine specific actions.

SM1b-a Determine why I am passionate about achieving my dreams.
SM1b-b Improve time management to help achieve personal goals.
SM1b-c Daily affirm why I will achieve my dreams and goals.
SM1b-d Work with team to achieve personal goals and dreams.
SM1b-e Help others establish and achieve their dreams and goals.

SM1c-a Become certified in ActionVision.
SM1c-b Follow the Student Life Management System each week.
SM1c-c Create an educational plan to achieve dreams and goals.
SM1c-d Determine type of life partner needed to achieve dreams.
SM1c-e Implement Life Masteries Life Balancing System each day.
SM1c-f Eliminate dream destroyers and implement dream builders.

SM1d-a Start part-time/full-time job to earn money.
SM1d-b Determine and do five best actions to succeed in job.
SM1d-c Identify three mentors to help me in my job.
SM1d-d Job: Improve analytical skills to perform better.
SM1d-e Job: Improve driver skills to perform better.
SM1d-f Job: Improve expressive skills to perform better.
SM1d-g Job: Improve amiable skills to perform better.
SM1d-h Develop detailed 12-month plan for success in job.
SM1d-i Learn to listen better and write notes on job.

SM1z-a
SM1z-b

Relationships
Number of actions in this section.
(4) #

SM2 Relationships
SM2a-a Sit down and talk with parents.
SM2a-b Write notes to one another (parents).
SM2a-c Parents: Maintain a love/success journal.
SM2a-d Date night with Dad/Mom.
SM2a-e Parents: Goal review (go out to breakfast).
SM2a-f Be more sensitive to each others needs.
SM2a-g Have fun times together.
SM2a-h Attend a play(s)/performance(s) together.
SM2a-i Help parents achieve their life goals.

SM2b-a Spend one-on-one time with relatives/family.
SM2b-b Phone and talk with loved ones.
SM2b-c Mail/e-mail notes of love and encouragement.
SM2b-d Fun time together as a family.
SM2b-e Exercise together with family/relatives.
SM2b-f Strive to appreciate differences of family members.
SM2b-g Affirm love and appreciation for family.
SM2b-h Help build life-long traditions with family.

SM2c-a Select great friends to build life dreams together.
SM2c-b Go out with friends for fun.
SM2c-c Help friends develop and follow life dreams.
SM2c-d Assist friends with school.
SM2c-e Support friends with challenges in their lives.
SM2c-f Develop new friendships.
SM2c-g Determine what type of friend you will be to others.
SM2c-h Help friends to grow spiritually.
SM2c-i Make decision to follow through on happy choices daily.

SM2z-a
SM2z-b

Education
Number of actions in this section.

(5) #

SM3 Education
SM3a-a Make school and studying fun.
SM3a-b Learn a trade or develop skills to earn a living.
SM3a-c Fully implement Student Life Management Fun Chart.
SM3a-d Complete all assignments __ days before due date.
SM3a-e Time block your day and achieve overall GPA of ___.
SM3a-f Develop and follow plan for each subject.
SM3a-g Become more organized in note taking and review.
SM3a-h Take personal initiative to study __ hours per night.
SM3a-i Develop and follow long-term educational plan.
SM3a-j Be tutored by someone in a challenging subject(s).
SM3a-k Tutor someone in your strongest subject(s).
SM3a-l Develop friendship with student in another country.
SM3a-m Learn to type and/or iimprove computer skills.

SM3b-a Develop and nurture __ number of close friendships.
SM3b-b Party with those who have strong values.
SM3b-c Do fun things with close or new friends.
SM3b-d Develop criteria and accountability for morals.
SM3b-e Develop criteria for life mate.
SM3b-f Be a great friend to others.
SM3b-g Help others who are less fortunate.
SM3b-h Help elderly individuals within community.
SM3b-i Develop and implement value-based friendship.
SM3b-j Be a wise steward of the trust others have in you.

SM3c-a Identify your interests (sport, hobby) and participate.
SM3c-b Implement detailed plan to excel in area of interest.
SM3c-c Daily discipline to achieve sports/interest goal.
SM3c-d Be mentored by someone successful in area of interest.
SM3c-e Mentor someone else in area of personal strength.
SM3c-f Help handicap or others in development of their lives.
SM3c-g Create ActionVision plan for area of interest.

SM3z-a
SM3z-b

Personal Development
Number of actions in this section.

(4) #

SM4 Personal Development
SM4a-a Exercise (___min/hr, ___ times/wk).
SM4a-b Follow plan for better eating habits or follow diet.
SM4a-c Stop smoking or other self destructive habit.
SM4a-d Read books throughout the year and write a summary.
SM4a-e Review personal/professional growth materials (a/v).
SM4a-f Follow plan for improving self confidence.
SM4a-g Follow plan for reducing stress.

SM4b-a Participate in events for charitable organization(s).
SM4b-b Attend a local church on regular basis.
SM4b-c Read the scriptures (__min/day, ___ times/wk).
SM4b-d Develop a success or prayer journal.
SM4b-e Volunteer in local school or child development center.
SM4b-f Share jokes and fun times with others.
SM4b-g Do something just for myself.
SM4b-h Write down and be accountable for morals & values.

SM4c-a Have date night with someone special.
SM4c-b Special quality time with parents, friends, siblings.
SM4c-c Develop and follow through with hobby/special interest.
SM4c-d Complete project(s) around the house.
SM4c-e Vacation and/or travel.
SM4c-f Take initiative to keep room clean & better organized.
SM4c-g Work on fun sport.
SM4c-h Phone: Call loved one / child / friend.
SM4c-i Write a note to a loved one / child / friend.
SM4c-j Develop and implement personal budget.

SM4d-a Learn to cook.
SM4d-b Learn to take care of myself and care for my home.
SM4d-c Learn to work around the house and/or equipment.
SM4d-d Learn skills that will provide a great living.
SM4d-e Obtain great job: __-experience, __-opportunity, __-income.
SM4d-f Develop and implement plan to start my own business.

SM4d-a Take intuitive in assisting with house work.
SM4d-b Help out with projects around the house.
SM4d-c Assist with taking care of siblings.
SM4d-d Take initiative on helping with laundry.
SM4d-e Take initiative on preparation/clean-up for meals.
SM4d-f Take initiative on ______________________________.

SM4z-a
SM4z-b

Spiritual Life
SM5a-a Understand that I was created very special.
SM5a-b Understand my purpose in life.
SM5a-c Determine my natural strengths, share them with others. SM5a-d Integrate my goals with my spiritual beliefs.
SM5a-e Determine/solidify my spiritual beliefs.
SM5a-f Grow in spiritual confidence and beliefs.
SM5a-g Work with parents to help me grow spiritually.
SM5a-h Identify someone who can help me spiritually.

SM5b-a Be mentored to improve understanding of Scripture.
SM5b-b Read Scripture consistently (__min/day, __ times/wk).
SM5b-c Memorize/apply scripture to my daily life (1 verse/wk).
SM5b-d Scripture other: _____________________________________.

SM5c-a Start praying or improve my prayer life.
SM5c-b Pray on a consistent basis (__min/day, ___ times/wk).
SM5c-c Pray - Implement a prayer journal.
SM5c-d Pray with family, friends, or accountability partners.
SM5c-e Pray other: _________________________________________.

SM5d-a Have someone help me to share my faith with others.
SM5d-b Witnessing: Scripture study with another person.
SM5d-c Witnessing: Share personal story with others.
SM5d-d Witnessing other: ___________________________________.

SM5e-a Get to know other spiritually strong people.
SM5e-b Fellowship - Attend church services regularly.
SM5e-c Fellowship - Have friends/others over to house.
SM5e-d Fellowship other: ___________________________________.

SM5f-a Assist others with physical needs.
SM5f-b Help those that are less fortunate than us.
SM5f-c Minister to other who have emotional needs.
SM5f-d Assist those who do not have parents.
SM5f-e Assist those who have financial needs.
SM5f-f Assist single parent with their special needs.

SM5z-a
SM5z-b

Life Masteries, Institute
29 W 150 Butterfield Rd.
Suite 201B
Warrenville, IL 60555
toll free (888)789-7878
Fax:(888)230-2301
www.lifemasteries.org

Planning Review

Planning Review

Please answer the following questions. Select a number between 1 and 10, with 10 being greatest.

1. Over the last 12 months did you have clearly defined goals?
Yes [ ] No [ ]

2. In the past, how would you rate your efforts to review and implement your goals and/or personal plan on a monthly basis?
1 2 3 4 5 6 7 8 9 10

3. How much do you believe ActionVision systems will help you focus on the great actions?
1 2 3 4 5 6 7 8 9 10

4. What is the likelihood that you will continue to follow this plan throughout the year?
1 2 3 4 5 6 7 8 9 10
,

5. What percentage of your current actions are completed to the level you now consider necessary?
______% (Note: It is not unusual to be around 20%.)

6. What percentage of the actions would you like to attain on a monthly basis?
______% (Note: We usually recommend between 70% and 85%.)

7. How would you rate your certified consultant's understanding of your own personal needs?
1 2 3 4 5 6 7 8 9 10

8. How would you rate the initial planning workshop or interview? (If applicable.)
1 2 3 4 5 6 7 8 9 10

9. What could be improved in this planning workshop or interview? (If applicable.)

10. Please make 2-3 comments about the service you received from your certified consultant.
(Please use reverse side of page.)

PLEASE COMPLETE SECOND PAGE OF REVIEW

11. Why would you recommend this planning system to other individuals, schools, or companies?

12. Please list the top two ideas that you received from the planning workshop or interview.

13. Can we use your comments, name, school, company name, and e-mail in marketing materials we distribute to potential clients? Yes [ ] No [ ] _______________________________
signature
14. Would you be interested in training sessions on:
[ ] Personality style selling.
[ ] Time management.
[ ] Advanced business planning training.
[ ] Project management system training.
[ ] Selling strategies to key accounts.
[ ] Speaking As A Pro®.

15. What other training or products would help you achieve your goals?
[ ] _________________________________
[ ] _________________________________
[ ] _________________________________

16. Would you recommend this system to friends and associates? Yes [ ] No [ ]

17. Most individuals will go on ActionVision as a result of being referred by someone else. If you believe this plan will assist you, we would request four referrals. They could be friends, family, neighbors. Literally everyone you know or come in contact with could benefit by being on ActionVision.

Name School/Company Yr. in School/Position E-mail or Phone Number
1) ____________________ ________________ _________________ _______________________

2) ____________________ ________________ _________________ _______________________

3) ____________________ ________________ _________________ _______________________

4) ____________________ ________________ _________________ _______________________

18. Would you be willing to call the above individuals and provide a recommendation? Yes [ ] No [ ]
Name:_________________________
Thank you, Mark Boersma Company:______________________
President, Life Masteries, Inc. Phone: (_____)_______-__________

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About LMI + Contact + Sponsors + Church/Missions + Non Profit Groups + Helping Children Reach Their Potential +
How To Improve Your Relationships + Win The Balancing Game Called Life + New Products + Home

Part A	Part B	Part C
Five Major Areas	% of time & focus	Number of actions
1) Dream/goals	(15%)___________________%	(3)___________________
2) Relationships	(20%)___________________%	(4)___________________
3) Education	(25%)___________________%	(5)___________________
4) Personal Development	(25%)___________________%	(5)___________________
5) Spiritual	(15%)___________________%	(3)___________________