Questionnaire for Conversation Diversity
Labels can put us in boxes. This said, diversity in a Living Room Conversation adds to the quality of the conversation. If you can give us some sense of where you identity on the dimensions represented below it will help us create greater diversity in your conversation. All of the questions below are optional and the information is only used for the formation of diverse conversation groups. Thank you!
Name *
Your answer
Organization (if applicable)
Your answer
Email *
Your answer
Would you like to be included in our private Living Room Conversations directory? (By checking "yes" you are agreeing to share your answers from this questionnaire to organize your own Living Room Conversations).
Are you interested in participating in a Living Room Conversation in-person, via video/web-enabled conferencing, or both?
Geographic location (City, State)
Your answer
Political leaning on social issues (e.g. marriage, abortion, gun control, etc.)
Liberal
Conservative
Political leaning on fiscal matters (e.g. taxes, trade, government spending, privatization, etc.)
Liberal
Conservative
Political party you most identify with
Age?
Race/Ethnicity
Conversation topics that interest you?
Your answer
To participate in a Living Room Conversation we ask you to agree to follow these common-sense conversation agreements: 1) Be curious and open to learning; 2) Show respect and suspend judgment; 3) Find common ground and appreciate differences; 4) Be authentic and welcome that from others; 5) Be purposeful and to the point; and 6) Own and guide the conversation
Please let us know your generally preferred availability for participating in a 2 hour conversation (specify time zone).
Your answer
We often take photos, record, and/or live-stream conversations and use these materials on our website, Facebook, and in other promotional materials. Do we have your permission?
May we share quotes from your feedback form after you have participated in a Living Room Conversation?
Anything else you'd like to share about yourself?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service