Melissa A. Little Consulting & Mediation Services LLC 
Intake Form
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Email *
What's your name?
What's your phone number?
Where do you work? (Company Name)
Where is your organization located?
What is the sector of your organization?
Tell us more about your organization and why you and/or your organization seek DEI services and/or mediation?
Please identify the type of training your organization would like to receive
How many participants will be attending the training?
When would you like for this service to begin? 
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Time
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What do you hope will be accomplished at the conclusion of your service?
Are you interested in other services?
If your organization has done DEI work in the past, please share the practitioner and describe the training that was provided. 
How did you hear about us?
Anything else you want to share?
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