Prospective Client Intake Form- Facilitation and Leadership

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for reaching out to UBUNTU Research and Evaluation to provide your organization services. UBUNTU Research and Evaluation is a professional learning community run by black women who use liberation and beloved community frameworks to evaluate, facilitate, and strategize with individuals, organization and communities.

What is the name of your organization? *

What is the size of your organization? *

What is the zip code of your organization's main address? *

Please share a link to your organization's website or other online presence. *

What is the full name of main point of contact? *

What is the main point of contact's title or position in the organization? *

What is the main point of contact's email address? *

What is the main point of contact's phone number? *

Please enter a 10 digit telephone number. ###-###-#### x###

Why have you decided to reach out to UBUNTU? *

Please include any information you have about current pain points, questions raised, or other desires relating to organizational learning facilitated by UBUNTU.

Clear form

Never submit passwords through Google Forms.

This form was created inside of Ubuntu Research and Evaluation. Report Abuse

Forms