This document is a motivation questionnaire that asks the respondent to list 3 personal and professional goals, what typically motivates them such as money or awards, and their preferences for various rewards like money, gift certificates, candy or paid time off. It also asks for their favorite cake, ice cream, candy bar, restaurant, music and movie theater as well as whether they enjoy public recognition.

1. Motivation Questionnaire
Please list 3 personal goals:
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
Please list 3 professional goals:
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
What motivates you: (i.e. money, gifts, awards, promotion opportunities, etc.)
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________________________________
Review the following rewards and choose an answer:
Love it! It’s fine Don’t bother
Money
Movie Gift Certificates
Restaurant Gift Certificates
Candy and Treats
Flowers
More training / responsibility
Paid time off
Please list your favorite:
Cake: ________________________________________________________________________________
Ice cream: ____________________________________________________________________________
Candy bar: ____________________________________________________________________________
Local restaurant: _______________________________________________________________________
Music: _______________________________________________________________________________

2. Local Movie Theater: ___________________________________________________________________
Do you enjoy public recognition? Yes No