TRAC Needs Assessment Form

Please take a few moments to answer the following questions so that we may tailor the program to your group's particular needs. Please return this form at least one week prior to your event. (It is very important for repeat groups to answer question number 11 so that we do not duplicate events from your last program).

1) Group Name:
2) Please describe your organization:
3) Event Day Contact Name: 3) Event Day Contact Name: Title First Last Suffix
Contact Phone#: Contact Phone#: - ### - ### ####
4) TRAC Course Date 4) TRAC Course Date / MM / DD YYYY
Number of attendees:
5) Age range of group:
How long has your group been together?
7) Does anyone in your group have a physical limitation that might affect their participation?
(Please explain)
8) What are the identified strengths of the group?
9) Which areas would your group like to address? (Check all that apply)

9) Which areas would your group like to address? (Check all that apply) Achieving Group Consensus Timing Confidence Coordination Effective Feedback Building Trust Conflict Resolution Motivation Communication Cooperation Group Focus Teamwork Balance Decision Making Other: Other:
10) Please outline several goals your group would like to achieve as a result of participation in the TRAC Program.
11) If your group has participated in our program before, please detail the activities they are familiar with so the facilitators can ensure your program is not repetitive.