Organization:

Organization Web Address:

Contact Person:

Position:

Email:

Phone:

Services of Interest (Check all those that apply):

Team ChallengeCollaboration ChallengeStrategic Thinking/PlanningSituational AwarenessBrainstorming Tools & TechniquesCreative Problem SolvingMeeting FacilitationBoard Development

Program Dates:

Please list two (2) prefered program dates:

When do you prefer your program:MorningAfternoon

Group Information:

Approximately how many participants?:

Approximate age range?:

Are there any special needs or requirements necessary for participation?:
YesNo

If yes please explain:

What current group development stage or stages best describe your group. (Check all that apply)
Forming…striving to become oriented towards each other.Storming…confronting various differences.Norming…have developed consensus regarding group norms and values.Performing…work as a unit to achieve group goals.

Assessment of Intent:

Please describe your intention for providing this group experience:

Please explain any possible group issues or conflicts that may present themselves during this experience:

List two (2) program accomplishments that will ensure the success of this experience:

Describe previous team events or professional development seminars your group has participated in:

Lastly, what are some of your questions or concerns at this point?:

     
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