Dialogue Session Feedback Survey Form
Share your feedback to help improve future dialogue sessions.
Session date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Dialogue topic
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Overall session experience
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1
2
3
4
5
How welcoming and inclusive did the discussion feel?
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Not at all welcoming
1
2
3
4
Extremely welcoming
5
1 is Not at all welcoming, 5 is Extremely welcoming
How well did the facilitator guide the discussion?
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Not well at all
1
2
3
4
Extremely well
5
1 is Not well at all, 5 is Extremely well
How well did the session support respectful listening?
*
Not well at all
1
2
3
4
Extremely well
5
1 is Not well at all, 5 is Extremely well
How comfortable did you feel sharing your perspective?
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Not at all comfortable
1
2
3
4
Extremely comfortable
5
1 is Not at all comfortable, 5 is Extremely comfortable
How useful was the session?
*
1
2
3
4
5
What worked well?
What could be improved?
Submit Feedback
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