Pre Dialogue Survey – Days of Dialogue

Days of Dialogue – Pre-Dialogue Survey

Thank you for registering for this dialogue. All questions are optional. Responses are anonymous and help us understand who we are reaching and how to best support this conversation.

Dialogue Title

Date

Time

Host / Partner Organization

Age Group

Gender

Ethnicity

Zip Code or City

Which best describes your role or connection?

Have you participated in a facilitated dialogue before?

What brings you to this conversation right now?

How familiar are you with this topic?

How open do you feel to hearing perspectives different from your own?

What feels hardest to talk about related to this topic? (optional)

What would make this dialogue feel worthwhile for you?