Steinbruck Center Group Assessment
Please fill out the following form, which will allow us to get to know you better and create an itinerary for your group.
Section I -- Contact information
What is your sending institution? *
Your answer
How did you hear about the Steinbruck Center? *
Your answer
Name of person responsible for booking *
Your answer
Email address for person responsible for booking *
Your answer
Phone number for person responsible for booking *
Your answer
Is the person booking your reservation going to be present with the group during the trip? *
If not, please provide us with the name, email, cell phone number of the group leaders.
Your answer
Is your group affiliated with a Christian denomination or religious group? *
Your answer
Section II -- Travel
Please note that without estimated arrival and departure times, we will be unable to create an itinerary for your group.
How is the group planning to travel to Washington, DC? *
Would you like the Steinbruck Center to purchase SmarTrip cards for the group in advance of your arrival? *
Passes cost $10 and come pre-loaded with $8.
Please share with us your arrival date. *
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Please share with us your arrival time. If not yet booked, please provide an estimated time. *
Time
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Please share with us your departure date. *
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/
DD
/
YYYY
Please share with us your departure time. If not yet booked, please provide an estimated time. *
Time
:
Section II -- Group Background & Demographics
What is the size of your group? *
Your answer
How many middle school participants are in your group? *
12 - 13 years old
Your answer
How many high school participants are in your group? *
14 - 18 years old
Your answer
How many college students are in your group? *
Your answer
How many staff/chaperones are in your group? *
Your answer
Describe the social, economic, ethnic and religious makeup of your geographic area. How does your institution compare with the surrounding community? *
Your answer
Describe the participants’ socio-economic backgrounds as well as the general racial/ethnic make up of your group. *
Your answer
What are the group members’ experience and knowledge of homelessness and its related causes? What is the level of interaction your group has had with people who are experiencing homelessness? *
Your answer
Are there any special circumstances or group dynamics you want us to be aware of? *
Your answer
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