Host Outcomes Survey

Question Title

* 1. Host name and contact info:

First Name

Last Name

Email Address

Phone Number

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* 2. How did you hear about On the Table: Racine?

Email from The Johnson Foundation at Wingspread

Personally contacted by Johnson Foundation staff

Social media

Local newspaper (in print or online)

Word of mouth from friend, family, coworker, etc.

Other (please specify)

Please tell us about your table:

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* 3. Was your table in-person or virtual?

In-person

Virtual

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* 4. Where did you meet?

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* 5. What time did you meet?

Start Time

Time

AM/PM

End Time

Time

AM/PM

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* 6. How many people attended your conversation?

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* 7. Who attended your conversation? (Please check all that apply)

Colleagues

Friends

Community residents

Students

Youth

People with shared interests

Family

Other (please specify)

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* 8. What 1-2 main topic(s) was(were) discussed?

Education

Economy

Health

Justice

Arts

Safety

Technology

Housing

Transportation

Equity

Identity

Other (please specify)

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* 9. What type of meal did you share? (Please check all that apply)

Breakfast

Lunch

Dinner

Coffee

Snacks

Home-cooked

Potluck

Catered

Dine-in

Picnic

Brown bag (bring your own meal)

Other (please specify)

Question Title

* 10. What were the outcomes of your conversation? (Please check all that apply.)

Participants shared new ideas/solutions on the community issue discussed

Participants shared next steps they plan to take

Participants met someone new

Participants left with a greater sense of community

Other (please specify)

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* 11. Please share your conversation outcomes in detail: (What new ideas or solutions were shared? What next steps did participants commit to take? Were there any comments you heard that you'd like to share?)

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* 12. Please indicate how much you agree or disagree that On the Table: Racine achieved its goals of encouraging healthy dialogue, fostering a connected community, and sparking collaborative action.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Encouraged healthy dialogue	Encouraged healthy dialogue Strongly agree	Encouraged healthy dialogue Agree	Encouraged healthy dialogue Neither agree nor disagree	Encouraged healthy dialogue Disagree	Encouraged healthy dialogue Strongly disagree
Fostered a connected community	Fostered a connected community Strongly agree	Fostered a connected community Agree	Fostered a connected community Neither agree nor disagree	Fostered a connected community Disagree	Fostered a connected community Strongly disagree
Sparked collaborative action	Sparked collaborative action Strongly agree	Sparked collaborative action Agree	Sparked collaborative action Neither agree nor disagree	Sparked collaborative action Disagree	Sparked collaborative action Strongly disagree

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* 13. How much do you agree or disagree that On the Table: Racine provided an opportunity to host a conversation that wouldn't have happened otherwise at this time.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 14. How much do you agree or disagree that after hosting an On the Table conversation, you felt an increased sense of belonging or connection to others.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Host Outcomes Survey

Question Title

* 1. Host name and contact info:

Question Title

* 2. How did you hear about On the Table: Racine?

Question Title

* 3. Was your table in-person or virtual?

Question Title

* 4. Where did you meet?

Question Title

* 5. What time did you meet?

Question Title

* 6. How many people attended your conversation?

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* 7. Who attended your conversation? (Please check all that apply)

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* 8. What 1-2 main topic(s) was(were) discussed?

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* 9. What type of meal did you share? (Please check all that apply)

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* 10. What were the outcomes of your conversation? (Please check all that apply.)

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* 11. Please share your conversation outcomes in detail: (What new ideas or solutions were shared? What next steps did participants commit to take? Were there any comments you heard that you'd like to share?)

Question Title

* 12. Please indicate how much you agree or disagree that On the Table: Racine achieved its goals of encouraging healthy dialogue, fostering a connected community, and sparking collaborative action.

Question Title

* 13. How much do you agree or disagree that On the Table: Racine provided an opportunity to host a conversation that wouldn't have happened otherwise at this time.

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* 14. How much do you agree or disagree that after hosting an On the Table conversation, you felt an increased sense of belonging or connection to others.

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* 15. Would you be interested in hosting a conversation again if we did this event in the future?

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* 16. (Optional) Please share any additional feedback or comments with us.