Needs Assessment Form

This Needs Assessment Form will help Dr. Taylor "Taylor-Make" his presentation to the specific needs of your group. Please answer all questions as completely as possible, but feel free to skip those which would duplicate a previous answer or which might be irrelevant to your group. Clicking on the "Submit" button at the end of the questionnaire will automatically email your information directly to our office.

Your Name:

Telephone:

Your Email:

Organization:

Address:

City:

State:

Zip:

Possible Presentation Dates:

Type of Presentation (such as keynote, featured workshop, full day training, multiple day workshop, etc.):

Anticipated Audience (# of teachers, Administrators, grade levels expected, etc.):

Goals for this Presentation:


Topics you want Dr. Taylor to include in his presentation:

Nearest Airport:

Distance from Airport to your location:


Additional Information:

This step is necessary to submit the form: Move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move »»