Professional Development Form

Leadership Coaching, Team Building, Retreat Facilitation

Thank you in advance for completing the Professional Development Intake Form. This form is designed for Higher Ground Consulting to learn more about your organization, team and vision. Completing this form is just the first step in allowing us to assess your unique set of needs and desired outcomes in order to design a custom made event for your organization.

Name(Required)

First Last

Email(Required)

Phone(Required)

Who are you and what is the name of your organization?(Required)

Please include your key contact information. Please also include any key sponsors and tell us about your end customers (who benefits from the outcomes of this training?)

Website URL of your organization?(Required)

Purpose of Event and Outcomes/Expectations

Reason(s) the event needs to happen: To prevent, continue, begin, stop, accelerate, develop/design, clarify, define, control, shift, change, improve, team building, etc.

Organizational Situation

Background,/history, cultural implications, conflict, growth, opportunities, effectiveness, successes/failures,

Event Date(s)

Duration: Number of hours, days, sessions

Event Location

Potential Locations: Group size and types of exercises will dictate the amount of room needed. Please note, it is the client's responsibility to secure a venue for the event

Number of Participants

Type of Participants

Same unit/level/department/team

Cross Functional Team

Leaders Only

Other

Level of Engagement

Level 1: In class cerebral challenges. Virtual or in person training where there is more of an emphasis on mental challenge components. In person training may include physical challenges typically limited to space requirements and size of group.

Level 2: Incorporates Level 1 challenges and team building with more physical challenges that require both traditional classroom time and space and that include larger spaces to accommodate some more physical challenges. Some of these challenges may occur outdoors

Level 3: These experiential educational challenges include the previous levels and are geared toward a combination of mental and physical outdoor adventures.

Key Resources

Please list any materials or samples that you are willing to share with us that will help us know your organization/team better (documents, files, recordings, materials, samples, articles, surveys, reports, meeting minutes, etc). Please also list key people we may contact and their information.

Other

Additional information that you feel may be helpful for your facilitator

What is your investment budget for this project?

Who can we thank for referring you to us?

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