Sample Pre-Dialogue Survey
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1. Sample Pre-Dialogue Survey for a Dialogue on a College Campus

 
We look forward to working with you during the upcoming dialogue session! Your responses to these questions will help us to plan the session. Only the facilitators will see what you write, and we will keep your responses strictly confidential. Please complete the survey by one week before the dialogue.

There is no need to use all the space provided, but please make your responses as specific as possible.

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1. What is your name?

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2. What is your email address?

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3. In which year do you expect to graduate?

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4. Are you affiliated with any Jewish organizations at ___, or organizations that address the Israeli-Palestinian conflict? If so, which ones?

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5. What leads you to want to participate in this conversation? What would you like to learn or experience? What do you hope to accomplish -- individually or as a community?

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6. Is there anything you can share about your background or your perspective on Israel that would help us to set up the program so that it is as useful as possible for you? You may want to tell us about your personal or family background, past experiences discussing Israel, political commitments or activism, or anything else that seems relevant.

7. Is there anything you can share about past experiences discussing this issue across political differences, positive or negative? Those experiences could be conversations with other students at ____ or conversations that have happened elsewhere.

8. Do you have any concerns about the dialogue? Could anything happen during or after the dialogue that might cause you to regret having participated?

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9. Is there anything that you anticipate being difficult for you in this conversation?

10. Do you have any suggestions for enhancing the possibility of this being a constructive conversation? Do you have any questions for us?

11. May we contact you if we have any follow-up questions about your needs or concerns about the dialogue?