This survey is designed to help you decide if owning a franchise, in particular a Home Instead Senior Care^® franchise, is the right business opportunity for you. At Home Instead Senior Care, we are looking for mission-focused individuals who demonstrate a commitment to seniors.

This survey is a self-assessment tool. Your results will not be shared with Home Instead Senior Care unless you specifically choose to do so upon completion of the survey. So we invite you to relax, take your time, and use this tool to help evaluate if Home Instead Senior Care could be the franchise for you.

Note: The results of this survey are not part of the official Home Instead Senior Care Franchise application and in no way imply your eligibility to be awarded a franchise.

Question 1:

Please indicate the importance of each of these characteristics in your next job opportunity:

	Very Important	Somewhat Important	Neutral	Not Very Important	Not Important At All
Being a leader
Running a successful business
Being my own boss
Stability and security
Opportunities for growth and improvement
Working with an established brand
Working with other business owners

---

Question 2:

Please rank your skills in the following areas:

	Very Strong	Somewhat Strong	Average	Not Very Strong	Not Strong At All
Setting goals for myself
Giving advice to others
Taking advice
Communicating with others
Identifying and developing talent in others

---

Question 3:

Please rank your skills in the following areas:

	Very Strong	Somewhat Strong	Average	Not Very Strong	Not Strong At All
Marketing myself
Managing others
Convincing others of my way of thinking
Asking for help

Question 4:

Please indicate how much enjoyment you receive or expect to receive from each:

	Enjoy a Great Deal	Enjoy Somewhat	Neutral	Don't Enjoy Very Much	Don't Enjoy At All
Working with children & young adults
Working with adults
Working with seniors
Working with employees

---

Question 5:

Please indicate how much enjoyment you receive or expect to receive from each:

	Enjoy a Great Deal	Enjoy Somewhat	Neutral	Don't Enjoy Very Much	Don't Enjoy At All
Face-to-face sales
Building relationships
Networking

---

Question 6:

Please indicate the importance of each:

	Very Important	Somewhat Important	Neutral	Not Very Important	Not Important At All
My ability to impact people's lives
Pride in what I'm doing
Doing the right thing
Making the best business decision

Question 7:

Please rank the following in order of importance:

	Customer service	Financial success	Quality of life
Most important
Important
Least important

---

Question 8:

Please select the three qualities that best describe you:

Structured	Fair
Inventive	Compassionate
Competitive	Driven
Conservative

---

Question 9:

Please indicate your level of experience in each of these areas:

	Less than 1 year	1-2 years	3-5 years	6-10 years	More than 10 years
Caring for a senior
Working as a caregiver
Filling a leadership role within another organization
Running my own business
Managing employees

Your Results

Thank you for completing our survey. We know that owning your own business is a big step that shouldn't be taken lightly. While your responses may not indicate that you are a perfect match for our company, only you can truly know if becoming your own boss is right for you.

Perhaps some of these other resources will help guide your decision:

• Do You Have the Mindset and Skills to be an Entrepreneur?
  From SCORE, the Counselors to America's Small Business
• What makes a good entrepreneur?
• What is an Entrepreneur?

Your Results

Your responses seem to indicate that you possess many of the traits that can be indicative of a successful Home Instead Senior Care franchise owner. Please use the form below to send us your contact information so that we can follow up with you personally.

At Home Instead Senior Care, we are committed to awarding our franchises to the best possible owners who are committed to helping improve the lives of seniors. We look forward to hearing from you soon. Remember, your answers and results will be shared with us unless you select "No" in the form below.

Send Us Your Information

• * First Name:
• * Last Name:
• * Postal Address:
• * City:
• * State/Province: Select State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Foundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Yukon Territory
• * Zip/Postal Code: Include space for Canadian Postal Codes
• * Country:
• * Email Address:
• Phone:
• Best time to call: Select Best Time 8:00AM - 10:00AM 10:00AM - 12:00PM 12:00PM - 2:00PM 2:00PM - 4:00PM 4:00PM - 6:00PM
• In what city/area(s) would you like to locate your business?
• * City:
• * State/Province: Select State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Foundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Yukon Territory
• * Would you like to share your answers with Home Instead?
  Yes     No
• * required fields

---

Need more information?

Let's talk! Call us at 402.498.4466 or toll free, 888.484.5759

Go Back	Next Section     Get Results

Thank you! We have successfully received your information. We will follow up with you shortly regarding franchise opportunities. In the meantime, we invite you to explore our Web site for additional information or to contact us directly at 402-498-4466, or toll free, 888-484-5759.