HOW CAN I SUPPORT YOU?

Thank you for your interest in working with me!

Your responses to this form will help us make the most of our initial consult.

It should take 5-10 minutes to complete.

Please allow 3-5 business days for a follow up response via email.

CONTACT INFORMATION

Name

Personal Pronouns

Name of university, organization or institution

Website of university, organization or institution

REQUEST DETAILS

Which of the following are you inquiring about?

If you have multiple requests, please submit a separate form for each

What challenges or opportunities do you hope to address through our work together?

What changes or outcomes would you like to see as a result of this work together?

AUDIENCE + LOGISTICS

Who are the participants?

Please offer any context that helps me understand who will be in the room

Number of participants

Length of event / experience

In-person or virtual

Where are you located or where will the event be held?

City, country, time zone

Anticipated dates or timeline for event / experience?

Do you have any access, inclusion, or cultural considerations I should know about?

FINANCIAL CONTEXT

How will our work together be funded?

e.g. internal budget, grant, donor, out-of-pocket for each participant

What is your budget for our work together?

ADDITIONAL INFO

Why are you interested in working with me, specifically?

How did you find out about me / my work?

Anything else you feel is important for me to know?