community partner assessment form

The next step to connecting as a community partner

COMMUNITY PARTNER LEADER NAME

First Name

Last Name

GROUP NAME OR TITLE

SUMMARY

Provide a brief summary about your proposed activity(ies)

PHONE

(###)

###

####

EMAIL ADDRESS

PURPOSE & GOALS

spend a little more time describing your group and what you hope to achieve when using the space.

TIME FRAME

For how long do you hope to utilize the studio? One session? several sessions? date and time range? be as specific as possible.

COMMUNICATIONS

What is the best and most reliable way to reach you? Please check all that apply:

email

text

facebook messenger

phone call

Other

SPECIAL CONSIDERATIONS

What else do we need to know about you or the community you represent. Do you have any physical or learning disabilities, transportation concerns, family concerns, mental health considerations, that you would like to share?

AGREEMENT

By checking the following you agree to:

Have your sessions documented and shared publicly

Communicate clearly about barriers you are encountering.