Divided Loyalties
How do you deal with the competing demands of
nurturing your family and growing your career?
FIRST, THANK YOU FOR TAKING THE TIME TO ANSWER THESE QUESTIONS. I KNOW
YOU ARE BUSY, SO IT MEANS A LOT TO ME AND TO THE MANY PEOPLE WHO WILL
BENEFIT FROM YOUR INSIGHTS, THAT YOU HAVE INVESTED THE TIME TO SHARE YOUR
EXPERIENCE.

PLEASE FEEL FREE TO ANSWER ANY OR ALL OF THESE QUESTIONS, AS BRIEFLY OR
COMPLETELY AS YOU WOULD LIKE. YOU ARE ALSO WELCOME TO
CONTACT ME DIRECTLY
IF YOU WANT TO SHARE MORE OF YOUR IDEAS AND EXPERIENCES.
1.  What are your top 3 priorities?  (children, health, marriage, professional development, job, caring  
for aging parents, or other)
2.  Do you spend the majority of your time on these 3 top priorities?  If not, why not?  What do you
spend the majority of your time on?
(757) 595-6808
3.  Are you involved in hobbies, community or church activities, fitness programs or other special
interests?
no
If so, what do you do?  How many hours per week do you spend in these activities?
4.  Do you have a role model  whom you admire for her gracious ability to do and have it all?
no
Who is that person and what do you think is her secret?
6.  I define caretaker success as: (I purposefully phrased the question this way, to include a variety
of circumstances. There are those of us who raise children, care for aging parents or special
needs siblings, sick neighbors, etc.)
7.  What has been your biggest challenge in dealing with your Divided Loyalties?  Have you resolved
this?  If so, how?
8.  What do you do when you are stressed out?  Do you have a specific way that you regain your
equilibrium?
9.  What is a lesson you learned the hard way?
10. If you could give one piece of advice to someone who is struggling with Divided Loyalties, what
would that be?
11. On a scale of 1-10, how do you rate your level of satisfaction with your professional performance/
status of your career?       (completely dissatisfied=1  &   totally satisfied=10)
If 6 or above, what are two specific elements that cause you to be satisfied?If 5 or below, what are two
specific elements that contribute to your dissatisfaction?
12. On a scale of 1-10, how do you rate your level of satisfaction with your family situation/ close
personal relationships?       (completely dissatisfied=1  &   totally satisfied=10)
If 6 or above, what are two specific elements that cause you to be satisfied?If 5 or below, what are two
specific elements that contribute to your dissatisfaction?
What is the highest level of education you have attained?
What is/are the age(s) and gender(s) of your child/children/grandchildren?
no
Are you interested in further participation in this study?
no
PERMISSIONS   Please choose from the following options:
Yes, I agree to be quoted directly. I have provided my contact information so I can be credited
appropriately

Yes, Im glad to contribute my ideas and you are welcome to incorporate them into your book
and seminars, but please do not use my name or any identifiable characteristics

Yes, please add me to your mailing list, and please notify me when your book is available
We know that time is often your most precious commodity.
THANK YOU for participating in this survey!
TM
Best Wishes, Hayley
(Note: Boxes will expand to accommodate your answers)
yes
yes
5.  I define career success as:   
ABOUT YOU
What is your gender?
What is age range?
What is your marital status?
What is your occupation?
Number of years in this field?
Are you self-employed?
yes
yes
CONTACT INFORMATION:
First name:
Last name:
Phone number:
Best time to call:
Email address:
Street:
City:
State:
Zip code: