Foggy Day
 
      • Day of Dialogue Placement Form
      • Intergroup dialogues depend on bringing people with different perspectives on an issue into a sustained conversation. Because of this, we need to make sure that the group of participants has a broad set of perspectives. Your filling out this form will allow us to select the group of participants that will maximize the dialogue's effectiveness, as well as help facilitators best prepare for the sessions. Note also that answering some questions is optional. Only questions marked with an asterisk are required.


        Your responses to these questions will be kept private, and will only be used to balance the composition of our group of participants.

        Thanks for the time you are taking to complete this form, and for volunteering to participate in this program.

      • 1. *Name
      • 2. *Email address
      • 3. *Phone number
      • 4. *Campus mailing address
      • 5. *What is the best way to reach you?
        • Email
        • Phone
        • Physical mail
      • 6. Years at Hampshire
      • 7. Age
      • 8. Sex
        • Female
        • Male
        • Intersex
      • 9. Gender
      • 10. Nationality
      • 11. Ethnicity
      • 12. Disabilities, if any
      • 13. *Which of the following sessions is your first choice?
      • 14. Which of the following topics is your second choice? (We will do our best to place you in your first choice)
      • 15. What do you hope to gain from participating in this program?
      • 16. Do you have any concerns about participating in this program?
      • 17. Please use the space below to let the organizers know any other thoughts you think might be useful in our preparations.
 
 

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