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* 1. Name

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* 2. Email

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* 3. Agency

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* 4. When were you trained on the Around the Table Curriculum?

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* 5. Curriculum You Might Facilitate

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* 6. How many times do you think you will run this curriculum virtually in the next 12 months?

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* 7. How many times do you think you would you run an in-person Around the Table workshop series in the next 12 months?

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* 8. Once you implement, would you be willing to be a share your experience with other trained implementers during a live session?

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