Request for educational presentation or guest speaker (needs assessment)
A needs assessment is an approach to determine the state of knowledge, ability, interest and attitude of the group we will be presenting to. With this information we will be able to tailor your learning experience. Please complete the attached, it should take you about 10-15 minutes. If you have any questions please email us at education@pflagdurhamregion.com
Email address *
Needs Assessment
Date - please suggest 3 possible dates
Suggested Date - 1 *
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Suggested Date - 2
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Suggested Date - 3
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Time - please suggest 3 possible times
Suggested time - 1 *
Time
:
Suggested time - 2
Time
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Suggested time - 3
Time
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Contact Details
Contact Name/Title: *
Telephone: *
Email *
Organization: *
Are you a PFLAG member?
Presentation Details
Scheduled Length of the Presentation? *
Will we run into a meal time?
Will the participants require a break?
Audience
Who is our audience? *
What is the audience's group identity?
To what extent are they educated, informed or experienced on issues of sexual orientation and/or gender identity? Have they had previous training?
Are the participants using personal or work time?
Is participation mandatory or volunteer?
How many people should we expect? *
What is the age group of participants?
Organization Culture
Does the current environment support sexual orientation and gender diversity?
Clear selection
Please explain:
Is the presentation proactive or reactive? *
Please explain:
Anticipated Outcomes or Goals
What are your goals? What knowledge, understanding and/or information do we wish to impart?
Why will audience members want to attend?
What are they expecting to learn? *
Promotion
How will the presentation be promoted?
Space and Equipment:
Additional Details:
Equipment Available:
Additional Details:
Where is the presentation room located?
Is the space barrier-free?
What is the earliest we can access the room?
Where are the washrooms located in relation to the presentation room?
Content Suggestions
Introduction:
Lecture:
Experimental Learning:
Review:
Discussion/Questions: *
Suggested Donation
Train the Trainer: $250/person
LGBTQ 101: $50/person
Trans 101: $50/person
Building Compassion for LGBTQ Seniors: $50/person
Positive Space $75/person

If cost is prohibitive, please discuss this with the Executive Director or Education Director.
Thank you for completing this needs assessment. We will be in contact with you shortly to discuss next steps.
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This form was created inside of PFLAG Canada Durham Region.