Pre-Program Questionnaire
This pre-program questionnaire is to assist CF4L in preparation of our presentation to your group. Our objective is to meet your specific needs. In order to do this, we need your help! Please take a few moments to answer the information below to the best of your ability. Feel free to provide any additional support information that will assist in this effort, i.e., school reports, news articles, etc. Please use your browser's print button to print out this form and fax it to: 773-723-2657.
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General School Information
Complete Official School Name:
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Other name or acronym the school/group uses:
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School Slogan and Mascot:
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Presentation/Program Specifics and Objectives
Conference/Program Theme:
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Specific Presentation Title:
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Date: _________ Start Time: __________ End Time: __________ Length: _________
For all day training: When do you prefer the breaks/lunch to occur? _________________
What is on the program right before we speak?
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What happens on the program right after we speak?
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Specific purpose of this meeting (award banquet, annual meeting, training, etc.)
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What are the specific objectives for the CF4L presentation?
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What would make the CF4L presentation really “special” for your group?
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What needs to happen as a result of CF4L participation for you to consider this event a success? (Please be as specific as possible.)
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Sensitive issues that should be avoided?
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Attendance/Audience Profile
Number of students attending? _________ % male: _________ % female: ________
Age range: _______ - _______ Avg. age: _________ Faculty attending? _________
Are students coming voluntarily or is it mandatory? Voluntarily Mandatory
If mandatory, are there any special incentives for students?
Background
Who are the other speakers in the program/celebration?
Speaker: _______________________________________________________________
Topic: _________________________________________________________________
Speaker: _______________________________________________________________
Topic: _________________________________________________________________
What speakers have you used in the past that covered topics related to the material CF4L will be presenting for you?
Speaker: _______________________________________________________________
Topic: _________________________________________________________________
Speaker: _______________________________________________________________
Topic: _________________________________________________________________
Speaker: _______________________________________________________________
Topic: _________________________________________________________________
What did you like and/or dislike about these presentations?
(Without their names if you prefer, but please comment on the material used.)
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Name the key people who will be in our audience. With your permission, we would like to contact them for more research information on your organization/group?
Name: _________________________________ Phone: __________________________
Name: _________________________________ Phone: __________________________
Name: _________________________________ Phone: __________________________
Details About Your Audience
Recent Achievements?
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Problems/Challenges your students face?
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What separates your high-performance students from others?
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Logistics
Introducer’s name: __________________________ Title: ________________________
Note: an introduction can be provided upon request. Would you like one? Y / N
Is there any publicity work CF4L can do for you while at your event? Please let us know in advance so we can arrange travel.
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Will the presentation be taped? Y / N Audio? ____________ Video? ______________
(Please remember that we will need to give permission to tape CF4L presentations.)
Travel Information
Best airport to arrive at: ____________________________________________________
Recommended/Event hotel: _________________________________________________
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Phone: _________________________________________________________________
Location at the site, room, etc: _______________________________________________
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Emergency contacts:
Name: __________________________________ Title: __________________________
Business Phone: ___________________ Home Phone: __________________________
Pager: ____________________________ Mobile Phone: ________________________
Name: __________________________________ Title: __________________________
Business Phone: ___________________ Home Phone: __________________________
Pager: ____________________________ Mobile Phone: ________________________
Thanks you again for this opportunity to serve you.
