UPR's 'One Small Step' Questionaire
One Small Step is a national project launched by StoryCorps with the goal to break down barriers created by politics. We hope to remember our shared humanity and know that we have more in common than we think, and that treating those with whom we disagree with decency and respect is essential to a functioning democracy.

Our aim is to put two people in front of microphones and just talk. We are seeking people from all around the state of Utah, from all different backgrounds to have this experience. If you would like to be considered for the 'One Small Step' Project, please fill out this form. If you are chosen, a facilitator from UPR will contact you. Not all applicants will be chosen.

The more information you submit about yourself in this form will be helpful to the facilitators, but know that all questions, except for your name and email, are completely optional.

Name (First, Middle, Last) *
Your answer
City of Residence
Your answer
State
Your answer
Zip Code
Your answer
Primary Language Spoken
How did you hear about One Small Step?
Your answer
Email address *
Your answer
Best phone number to reach you
Your answer
Preferred method of contact
Best time to contact you? (morning, afternoon, evening - be as specific as you need)
Your answer
Age
Your answer
Gender
Religious affiliation
Your answer
Race/Ethnicity
Your answer
Occupation
Your answer
Do you consider yourself...
When you consider your political thinking, which of the following best describes you?
Please describe your ideal partner for this conversation (in terms of ideology, beliefs, etc.)
Your answer
What do you want to achieve by participating in a conversation with someone who holds a different political viewpoint? Please explain in 3 sentences or less.
Your answer
Do you have any concerns about participating in a conversation with someone who holds different political views than your own? Please explain in less than 3 sentences.
Your answer
What time of day is best for you to participate?
Please describe yourself, including any details you think a potential conversation partner should know about you. If you are chosen, this short bio will be shared with your conversation partner prior to your discussion together.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service