Retreat Facilitation Intake Form

Thank you for your interest in the UNC School of Government’s facilitation services. As a first step, please provide responses to the questions in the intake form below. Short, summary responses are sufficient. This will help us to understand your needs and guide initial discussions about how we can support you or help to find someone who can. If you have question, you can contact John Stephens at stephens@sog.unc.edu, 919-962-5190, or Kim Nelson at knelson@sog.unc.edu, 919-962-0427.

If you are interested in strategic planning services, please contact Obed Pasha at pasha@unc.edu or visit this webpage: https://strat-plan-perform-mgmt.sog.unc.edu

Please note that we generally require more than one month’s notice to accommodate facilitation requests.

Name *

Position/Title

Organization *

Address

Phone

Email *

Meeting Date *

Month

Day

Year

Number of Days *

Alternative Date

Month

Day

Year

Format *

virtual

in-person

If in person, location:

Brief description of the group (# in group, membership, history, etc.) *

Have you used a facilitator(s) before? Who? *

Topics, objectives, issues or difficulties for the group (specific examples)? *

Why is a facilitator desired? Does the entire group want one? *

Willing to use a co-facilitator? *

Yes

No

Who will choose the facilitator(s)? *

Willing to have a (mandatory) planning meeting at least one month in advance of the retreat date? *

Budget (Fee? Expenses?) *

Other notes