Community & Professional Support Request Form

Thank you for reaching out to us.

We are so pleased to have the opportunity to learn more about you and your organization or group.

Please take 5-10 minutes to complete the form below so that we can get a better sense for your current needs.

Name

First Name

Last Name

Organization

Website

http://

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you learn about our services?

What services are you interested in?

Consultation

Group Process Facilitation

Training

Tell us a little more about your reason for seeking support at this time

What type of organization or group do you represent? What sort of work do you do together?

What is the size of your organization or group? Will the whole group or organization be participating? If not, who will be participating? About how many people?

Was/is there a particular change, event, or concern that prompted you to reach out or a particular goal you are wanting to focus on?

What are some strengths of your group or organization?

Does your organization have any particular cultural or other identities that are important for us to know about?

What are you hoping to get out of our work together?

Do you have any questions for us?

Is there anything else you think we should know?

Thanks for reaching out. We look forward to talking with you soon. Someone will get back to you within the next 7 days.