(OTF) Organizational Training & Facilitation Intake Form
circles, training, or dialogue facilitation for groups
Initiating Person's Name
Initiating Person's company or organization name (if applicable)
Initiating Person's Email
Initiating Person's Phone Number
Initiating Person or organization's address
Another Person's Name (if applicable)
Other Person's Email (if applicable)
Other Person's Phone Number (if applicable)
How do you hope conflict resolution or training can help?
Type of Dispute or Training Topic
-- Select --
Community Harassment: Other
Community Housing: Tenant Conflict
Community Building: getting to know each other or strengthe
I am seeking Conflict Education
I am seeking Strategic Planning assistance
Local / Municipal Public Group Facilitation
State Public Group Facilitation
Restorative Practice Implementation: District
Restorative Practice Implementation: School
Workplace: Conduct
Workplace: Employee Conflict
Improve Workplace Culture
Improve Workplace Environment
Other: Arbitration (not MPHA)
What type of group or organization is requesting CRC's services?
--Select--
Center Website
Community Organization: Community Center
Community Organization: General
Community Organization: Neighborhood Association
Community Organization: Volunteer Mediator
Landlord - Group: Non-Profit
Landlord - Group: Private
Landlord - Group: Public
Landlord - Group: Public Housing Authority
Schools: Minneapolis Public School
Schools: MSU College of Liberal Ar
Schools: Duluth Denfeld
Schools: St. Cloud Apollo
Schools: St. Cloud CAAP
Schools: St. Cloud McKinley High S
Schools: St. Cloud North Jr High
Schools: St. Cloud South Jr. High
Schools: St. Cloud Tech
Unstated
Other (specify)
Relationship of Participants
- Select -
Co-Workers
Employer - Employee
Home Owner Assoc - Owner
Landlord - Tenant
Neighbors
Roommates/Housemates
School - Student/Parent/Guardian
Student - Staff
Student - Student
Youth - Parent/Guardian
Other
Do you plan to participate or are you referring others?
No, I am referring others
Yes, I plan to participate
Additional Referral Information
What CRC Center are the participants closet to?
- Select -
Minneapolis
Duluth
Greater MN
What pronouns would you like us to refer to you by? (check all that apply)
She/Her
He/Him
They/Them
Other (mark other preferred pronouns in notes section)
County this will serve
- Select -
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac qui Parle
Lake
Lake of the Woods
Le Sueur
Lincoln
Lyon
Mahnomen
Marshall
Martin
McLeod
Meeker
Mille Lacs
Morrison
Mower
Murray
Nicollet
Nobles
Norman
Olmsted
Otter Tail
Pennington
Pine
Pipestone
Polk
Pope
Ramsey
Red Lake
Redwood
Renville
Rice
Rock
Roseau
Scott
Sherburne
Sibley
Stevens
Swift
St. Louis
Stearns
Todd
Traverse
Steele
Wabasha
Wadena
Waseca
Washington
Watonwan
Wilkin
Winona
Wright
Yellow Medicine
Not Reported
Outside Minnesota
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