Here's the draft Sandy sent out a few weeks ago. Use the "Edit this Document" link at the bottom of the page and add your comments under each element you have an opinion on (followed by your name in parentheses). Once people's comments are in there, we'll rewrite/edit the document as a whole and then go from there. You can also add general comments using the Comment field below.

Feedback Form for Let*s Talk America Events/Programs

Contact information Name, Organization, Email, Phone, Address, URL

Your role in the program you*re reporting on (facilitator, organizer, etc.):

The Basics Date(s) of your Let*s Talk America program: Location and venue of program (i.e. A Catholic Church in New York City): Organizer(s) of the program:

Participants in the Program Number of participants: Number of groups (i.e. two dialogue groups met simultaneously):

Demographic details (not to be published online) Please provide any information you may have regarding the age range of participants, the races/ethnicities represented, political parties/perspectives represented, gender breakdown, etc.

Facilitators How many facilitators did you utilize for this program?

Demographics of facilitation Please provide details about the facilitators* identity or perspectives that are most relevant to the issue discussed (age for an intergenerational dialogue, race/ethnicity for a race relations deliberation, etc.).

Content of the Program

What dialogue or deliberation model or technique did you use? Choices: Conversation Caf*, World Caf*, Face-to-Face Salon, Utne Caf*, Other

If you selected "other," please name or describe the model/technique you used.

Briefly describe the format of the program (i.e. 15 minutes of introductions, 20 minutes of participants* personal experiences, 40 minutes of examining the issues, etc.).

What main questions were posed by the facilitator during the program for discussion?

What, if any, educational or background materials were developed/used during or in preparation for the program? How were they used?

What key themes emerged during the dialogue/deliberation process (areas of common ground and disagreement, trade-offs that people were and were not willing to make, and actions they considered taking)?

Why did this issue matter to participants? What were their major concerns about the issue?

What were the major areas of agreement in how participants viewed the issue?

What were the major areas of disagreement in how participants viewed the issue?

What were the major questions that participants raised/identified that were still unanswered and important at the end of the program?

Outcomes of the Program

As the program progressed, did you observe any shifts in participants* thinking or in how they responded to others* perspectives? Please describe. (To ensure confidentiality, this will not be published online.)

Did individual participants suggest that they would do anything differently as a result of the dialogue/deliberation program (i.e. vote, read more about the issue, behave differently, etc.)? (This will not be published online.)

Did the group identify shared directions for action? What, if any, next steps were identified by participants?

What, if any, recommendations did participants formulate for decision-makers?

What actions were participants least willing to support as a group and why?

Stories that inspire

We would like to share stories about Let*s Talk America programs in order to inspire others to organize their own programs. Can you describe your program or an anecdote from your program briefly in a narrative format?

Lessons learned

Do you have any advice for others who are considering hosting a Let*s Talk America dialogue on this issue? Did you learn anything from this experience that will improve your work in the future?

Can you provide any examples of how difficult group or power dynamics (between liberals and conservatives, men and women, etc.) played out and were managed in your program?

Evaluation

Did you perform any evaluation or assessment of this program? If so, please share your findings with us.

Confidentiality

Tell us if you would like us to refrain from posting any of your responses on the web. As indicated, your responses to several of the questions will be kept confidential and used by researchers only. But if there are other responses that you would prefer not be posted (because they make an individual easily identifiable, for example), please tell us:

Additional Comments

Use the space below to tell us anything else you would like us to know about your program.

Further details

If you have prepared a press release, report, outcomes statement, etc. on this program, feel free to send it to us at ___.