PERSONAL-SOCIAL MIRROR INFORMATION SHEET

PERSONAL MIRROR
Personal Information This Is Me
Last Name:
First Name:
Middle Name:
Preferred Name:
Address:

Sex:
Age:
Height (cm):
Weight (kl):
Birthday:
Place of Birth:
Mother’s Name:
Father’s Name:
Religious/Spiritual Pursuit:

Language Known:
Nationality:
Ethnicity:

Physical Traits & Characteristics Personal Traits & Characteristics

Hobbies and Interests Skills, Abilities and Capabilities

How I See Myself as a Person

 MY FUTURE (Career and Personal Goals)

My Vision

5 Years from Now 10 Years from Now

15 Years from Now 20 Years from Now

My Retirement Plan My Legacy

 SOCIAL MIRROR

Person A

Name:
Relationship to the Person:

How long do you know the person?

What is your first impression about me?

How would you describe me as someone you know?

What sort of things that remind you about me?

Realization About My Personal-Social Mirror

 SOCIAL MIRROR

Person B

Name:
Relationship to the Person:

How long do you know the person?

What is your first impression about me?

How would you describe me as someone you know?

What sort of things that remind you about me?

Realization About My Personal-Social Mirror

 SOCIAL MIRROR

Person C

Name:
Relationship to the Person:

How long do you know the person?

What is your first impression about me?

How would you describe me as someone you know?

What sort of things that remind you about me?

Realization About My Personal-Social Mirror