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Pre-Program Questionnaire Barbara Rubel, MA, BCETS, CBS Griefwork Center, Inc., P.O. Box 5177, Kendall Park, NJ 08824 Barbara Rubel customizes each presentation and wants to contribute in a meaningful way to your upcoming event. Please answer all relevant questions skipping over any which may not apply due to the nature of your event. Send completed form to griefwork@aol.com. If you have any questions, contact Barbara at 732-422-0400.
Your Main Contact Information Primary Contact Person: Title: Organization: Address: Telephone: Cell Phone: Email: Website:
About Your Organization: Provide a brief description of your organization: What kind of year did your organization have last year? Describe the most significant changes in the last year that your industry faced. How successful are current services implemented to help the population you serve? What term is used in reference to your customer (families, clients, patients, consumers, students, residents)?
Program Goals What are the current problems that have made you contact Barbara? What is your overall goal for this presentation? How do you think hiring Barbara will help you meet your goal? What are your objectives for Barbara’s presentation? What are some of the reasons you think training is needed? What is the end result you are seeking from a training intervention?
Program Will there be any other speakers on the agenda? If so, what is their name and topic of presentation? What is happening before Barbara’s presentation? What is happening after Barbara’s presentation?
About Your Audience Male/female ratio: Average age of group: Number of participants expected: Spouses or children invited? Identify most important strengths of those in the audience: Identify most important weakness of those in the audience: If Barbara could talk with each participant individually, what would most of them say was most needed in this presentation? What else does Barbara need to know about this group that would help her connect with them? What “inside” information about the audience should Barbara use in her presentation? (a funny person, a birthday, anniversary, major announcement): What are the participant’s attitudes and expectations of this presentation? What are the top challenges facing the people who will be in the audience? Where have participants previously obtained knowledge on the topic you would like Barbara to speak? Are there any issues or topics Barbara should avoid or be sensitive to? What skills do the participants hope to retrain from Barbara’s presentation?
Meeting Information: Date Barbara is speaking: Presentation: Keynote o General Session o Breakout o Luncheon Speaker o Start time of Barbara’s presentation (be specific): End time of Barbara’s presentation (be specific): If there are any breaks, please indicate time allotted: Conference/Meeting begins and ends: Does your program have a theme? What does this theme mean to your group? What precedes Barbara’s presentation? What follows Barbara’s presentation? Who will be introducing Barbara?
Logistical Information Barbara will book her own hotel and flight reservation. Please indicate below preferred hotel, airport, and any information Barbara should know when planning her traveling schedule. Availability of Taxi or Shuttle Service from Airport to Hotel: Hotel (King, non-smoking preferred) Name and Address: Distance/Time Hotel is from Airport: Closest Airport: Distance/Time from Hotel to Presentation: Presentation Location:
Past Presentations What type of training has worked in the past? What did your group like or dislike about speakers in the past? Based on past training, do you feel the level of this training should be basic, advanced, or a combination of the two?
General Information What is the biggest challenge your organization is facing at this time? How will you evaluate this presentation when it is over? If you have a company/staff newsletter, please send it to Barbara. How will this program be advertised? Are there any taboo subjects Barbara should be made aware? Have there been any recent personal staff losses that Barbara should be made aware? What did Barbara not ask in this pre-program questionnaire that you think she should know? |
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