Needs Survey

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Needs Survey:  
   
*Your Name
Title
*Company Name:
*Mailing Address 1:
Mailing Address 2:
Suite:
*City:
*State:
*Zip:
Country:
*Phone(Office):
Extension:
Phone(Cell):
Phone(Other):
*Email:
Fax:
Website:
   
Type of Organization:
How can we help you?  
Type of department(s )/ Group:

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Number of people to attend: (approx)
What general issues/areas would you like to
improve in your department / organization:

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What specifically would you like to improve?

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What specifically would you like to reduce / eliminate?

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Have you identified what these issues are costing your dept/organization?:
If these issues improved, how would you be able to measure improvement? Please describe what would be different, qualitatively and quantitatively, if these issues improved?:
 
What do you perceive is currently getting in the way of these improvements?:
 
Is emotional reactivity or negative reactions to change or stress affecting your people?:
If, yes in what ways do you see this impacting performance or other goals?:
 
Have you observed an impact on:

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