Camp Manito-wish Leadership Program Referral Form

Contact Information

Name
Email address
Phone number
Address

Organization Information

Name
Email address
Phone number
Address
Web site

Describe your group

What is the composition of your group? Ages?


Are there tasks or specific purposes they work on together on a regular basis?


Describe what they do and what the outcomes are.


Describe how they do this.

What does their group process look like? Do they use a formal action plan or other organizational process? Are there very definite divisions with a few stronger, more forceful individuals in charge and many others following, or is there a more equal division of responsibilities?

What specific outcomes are you looking for from your Manito-wish Leadership program?


Please rank the following goals in importance, with the most important goal first

1 2 3 4 5 6 NA	Awareness of group diversity and interaction styles
1 2 3 4 5 6 NA	Communication and group process
1 2 3 4 5 6 NA	Personal leadership growth and development
1 2 3 4 5 6 NA	Specific action planning, brainstorming, or other group process skills.
1 2 3 4 5 6 NA	Activities focused on helping participants get to know and understand each other on a deeper level.
1 2 3 4 5 6 NA	Personal Challenge.

What additional follow-up work would you like to include in your program?