Winter 2011 Dialogues Survey

Thank you for your interest in participating in one of our upcoming dialogue sessions! We hope that we will be able to accommodate you. Once we have your information, we will get back to you as soon as possible about scheduling.

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1. What is your name?

What is your name?

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2. What is your email address?

What is your email address?

3. What is your phone number? (This question is optional, but it is helpful to have your number in case we need to inform about a last-minute change in plans.)

What is your phone number? (This question is optional, but it is helpful to have your number in case we need to inform about a last-minute change in plans.)

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4. Where would you like to attend a dialogue? (Please check all boxes that apply.)

Where would you like to attend a dialogue? (Please check all boxes that apply.) Center City Elkins Park	Main Line Mt. Airy	West Philly/University City
Comments?

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5. When are you generally available? (Check all that apply.)

When are you generally available? (Check all that apply.) Sunday afternoons

Sunday evenings

Monday evenings

Tuesday evenings

Wednesday evenings

Thursday evenings

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6. Have you participated in a Jewish Dialogue Group program before?

Have you participated in a Jewish Dialogue Group program before?

Comments?

Your responses to the following questions will help us to place you in a group that matches your particular needs and interests. There is no need to use all the space provided, but please make your responses as specific and detailed as you can.

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7. What leads you to want to participate in one of these dialogues? What are your hopes for the conversation? What would you like to learn or experience?

What leads you to want to participate in one of these dialogues? What are your hopes for the conversation? What would you like to learn or experience?

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8. Is there anything you can share about your perspective or background that would help us with our planning? You may want to share something about how you think and feel about the Israeli-Palestinian conflict, your personal or family history, past experiences discussing Israel, political commitments, or anything else that seems relevant.

We will keep your responses strictly confidential.

Is there anything you can share about your perspective or background that would help us with our planning? You may want to share something about how you think and feel about the Israeli-Palestinian conflict, your personal or family history, past experiences discussing Israel, political commitments, or anything else that seems relevant. We will keep your responses strictly confidential.

These optional questions will also help us to set up and facilitate the dialogue that reflects your particular needs.

9. Is there anything you can share about past experiences discussing these issues across political differences, positive or negative?

Is there anything you can share about past experiences discussing these issues across political differences, positive or negative?

10. Do you have any concerns about the dialogue? Is there anything that you anticipate being difficult for you in this conversation?

Do you have any concerns about the dialogue? Is there anything that you anticipate being difficult for you in this conversation?

11. Do you have any questions or suggestions about the program?

Do you have any questions or suggestions about the program?

Winter 2011 Dialogues
Exit this survey

1. Winter 2011 Dialogue Sessions

*
1. What is your name?

*
2. What is your email address?

3. What is your phone number? (This question is optional, but it is helpful to have your number in case we need to inform about a last-minute change in plans.)

*
4. Where would you like to attend a dialogue? (Please check all boxes that apply.)

*
5. When are you generally available? (Check all that apply.)

*
6. Have you participated in a Jewish Dialogue Group program before?

*
7. What leads you to want to participate in one of these dialogues? What are your hopes for the conversation? What would you like to learn or experience?

9. Is there anything you can share about past experiences discussing these issues across political differences, positive or negative?

10. Do you have any concerns about the dialogue? Is there anything that you anticipate being difficult for you in this conversation?

11. Do you have any questions or suggestions about the program?

Winter 2011 DialoguesExit this survey

1. Winter 2011 Dialogue Sessions

*1. What is your name?

*2. What is your email address?

3. What is your phone number? (This question is optional, but it is helpful to have your number in case we need to inform about a last-minute change in plans.)

*4. Where would you like to attend a dialogue? (Please check all boxes that apply.)

*5. When are you generally available? (Check all that apply.)

*6. Have you participated in a Jewish Dialogue Group program before?

*7. What leads you to want to participate in one of these dialogues? What are your hopes for the conversation? What would you like to learn or experience?

9. Is there anything you can share about past experiences discussing these issues across political differences, positive or negative?

10. Do you have any concerns about the dialogue? Is there anything that you anticipate being difficult for you in this conversation?

11. Do you have any questions or suggestions about the program?

Winter 2011 Dialogues
Exit this survey

*
1. What is your name?

*
2. What is your email address?

*
4. Where would you like to attend a dialogue? (Please check all boxes that apply.)

*
5. When are you generally available? (Check all that apply.)

*
6. Have you participated in a Jewish Dialogue Group program before?

*
7. What leads you to want to participate in one of these dialogues? What are your hopes for the conversation? What would you like to learn or experience?