P.U.R.P.O.S.E. Deep Dive Assessment

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The P.U.R.P.O.S.E. Deep Dive Assessment will help you reflect on your parenting journey, explore your current challenges, and assess your familiarity with the core concepts covered in the program. This ensures that you get the most out of your experience and receive the support you truly need.

Please answer each question honestly—there are no right or wrong answers! This is simply a tool to help guide your next steps toward growth, connection, and confidence in your parenting.

This is also your onboarding form if you choose to join the PURPOSE Transformation Program.

Email *

Full Name *

Spouse or Partner Name

Partner's Email

Birthdays - for everyone going through the program. List name and date.

Phone Number *

Address

City and Zip Code

Your Children's Names & Ages: *

What best describes your family structure?

Married

Single Parent

Blended Family

Co-Parenting

Other:

Clear selection

Section 1: Your Parenting Experience: Challenges + Goals

How would you rate your confidence as a parent

Struggle Bus!

Calm + Confident

Clear selection

What are your biggest parenting challenges right now? (Select all that apply)

Managing big emotions and meltdowns

Understanding my child’s behaviors

Setting boundaries without power struggles

Staying calm and regulated as a parent

Strengthening my relationship with my child

Creating a positive family culture

Other:

How would you rate your ability handle challenging parenting situations

I really struggle

I am equipped to handle them

Clear selection

What is your biggest parenting win or something you feel you're doing well?

Have you previously studied or practiced any of the following parenting philosophies or frameworks? (Select all that apply)

Conscious Parenting

Gentle Parenting

Positive Discipline

Nonviolent Communication

Attachment-Based Parenting

Polyvagal Theory

None of the above

Other:

How do you currently approach discipline in your home? (Select all that apply)

I use time-outs, consequences, and rewards to manage behavior.

I try to use connection-based discipline, but I struggle with consistency.

I focus on co-regulation and guiding my child through emotional challenges.

I am still figuring out what works best for my family.

I have no idea what to do!

Other:

What changes would you love to see in your home over the next 12 weeks? (Be as specific as possible!)

Section 2: Familiarity with Program Concepts

Have you heard of the concept of Power Over, Power Under, and Power With in parenting?

Yes, I understand and use these concepts.

I've heard of it but don't fully understand how to apply it.

No, this is new to me.

Other:

Clear selection

How familiar are you with brain development in children (e.g., "downstairs brain" vs. "upstairs brain")?

Very familiar—I understand how different parts of the brain develop and affect behavior.

Somewhat familiar—I’ve read about it but need more guidance.

Not familiar—this would be new learning for me.

Other:

Clear selection

Have you learned about the nervous system’s role in emotional regulation, including Polyvagal Theory?

Yes, and I actively use this knowledge in my parenting.

I’ve heard of it but don’t fully understand it.

No, this is new to me.

Other:

Clear selection

How do you currently support your child’s emotional regulation? (Select all that apply)

I encourage deep breathing, sensory tools, or grounding techniques.

I try to validate their emotions and stay present with them.

I sometimes struggle to stay calm myself when my child is dysregulated.

I rely on consequences to manage outbursts.

I need more tools to support my child’s emotional regulation.

How do you now handle ruptures (conflicts/disconnections) with your child, and how often do you repair them?

I repair every time, and I feel confident in how I do it.

I repair most of the time with growing confidence.

I repair when I remember, and I'm learning as I go.

I know it's important, but I'm still figuring out how to do it.

I rarely or never repair.

Other:

How would you describe your attachment relationship with your child now?

I don't know what attachment means and how it affects our relationship.

I understand attachment, but I struggle to consistently create felt safety with my child

I actively work to build secure attachment and my child seems more connected.

I feel secure in my attachment with my child, and they trust me as their safe base.

My child demonstrates secure attachment; they seek me out and know I'm their safe person.

Other:

How do you currently approach emotional awareness and response with yourself and your child?

I don't focus much on emotions; I tend to react when things get hard.

I notice emotions, but I don't always know what to do with them or how to guide my child through them.

I pay attention to emotions in the moment and try to respond thoughtfully, but I don't have a clear framework for it.

I regularly notice and name emotions, understand what triggers them, and guide my child through emotional challenges.

I'm very aware of emotions, understand triggers deeply, and actively teach my child emotional awareness and management.

Other:

How do you now set and maintain boundaries with your child?

I'm still figuring out what boundaries look like for my family.

I set boundaries, but I struggle to maintain them consistently.

I set clear boundaries and maintain them most of the time.

I set clear, intentional boundaries and maintain them confidently.

I set boundaries AND teach my child to set healthy boundaries too.

Other:

Section 3: Readiness for Growth

How do you currently take care of your own emotional well-being? (Check all that apply)

Exercise

Therapy or Coaching

Journaling

Prayer or Meditation

Time with Friends/Support System

I don’t currently have a self-care practice

Other:

How confident do you feel in handling challenging parenting moments?

completely lost

totally confident

Clear selection

What limiting beliefs or fears do you have about parenting? (Example: "I'm not patient enough," "I don't know how to help my child," etc.)

What strengths do you bring to your parenting? (Example: empathy, structure, playfulness, etc.)

On a scale from 1 to 10, how playful are you? *

Not playful at all

Very playful

What is your main goal for joining this program? (Select all that apply)

I want to transform my parenting approach and learn new tools.

I need support navigating my child’s emotions and behaviors.

I’m looking for a deeper understanding of my own triggers and how they affect my parenting.

I want to build a stronger connection with my child.

How open are you to shifting your mindset around parenting?

Very open—I’m ready for a new approach.

Somewhat open—I’m curious but skeptical.

Unsure—I need more information before committing.

Other:

Clear selection

This program involves self-reflection and personal growth. How comfortable are you with exploring your own patterns and past experiences as they relate to parenting?

Very comfortable—I’m eager to dive in.

Somewhat comfortable—I’m willing but a little nervous.

Unsure—I don’t know if I’m ready for that yet.

Other:

Clear selection

Is there anything else you’d like me to know about your parenting journey or challenges?

Thank You!

I can’t wait to support you in this journey! I’ll review your responses and tailor our sessions to meet your needs.

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