Online Program Questionnaire
In order to provide your program with the best possible service, help us by describing your needs and your facilitation/program requirements. We’ll use the information you provide to match the program design with your input.

Intake tips:
Please be very detailed and as specific as possible when filling in this form.
This form should reflect your individual program needs and expectation
Organization Name:
Contact Person:
Date of Event: Time/Duration:
Phone: Fax:
Email:
Mailing Address:
Participant #:
Definition of Successful Session:

-Short Term -Long Term

Any participants with special needs? Yes
No
Additional Program Needs/Concerns
Preferred Program Site: On Site
Other
Ropes Course:

3 hrs 4.5 hrs 6 hrs
Preffered Program Length:

Half Day (3 hrs) Full Day (5 hrs) Custom

* Which of the following elements are important for this program
(check all that apply)

High Performance Teambuilding:

Leadership Development

Confidence
Cooperation
Effective Feedback
Decision Making
Motivation
Exploring Diversity
Entertainment/Live
Teamwork
Problem Solving Skills
Team Spirit
Peer Respect
Play/Fun
Trust Building
Creativity
Achieving Group Consensus
Developing Effective Communication
Balance

Professional Development Workshops & Trainings:

Diversity

Stress Management
Customer Service
Interviewing & Selection
Meeting Management
 
Personality Type Assessments:
 
Myers Briggs Type Indicator
DISC
Emotional Intelligence