Roots of Resilience Action Guide Order Form
Please fill out the following form if you would like to facilitate a Roots of Resilience Action Guide small group study. The Roots of Resilience Action Guide is designed to steer five 90-minute small group discussions that explore the groundbreaking Adverse Childhood Experiences (ACEs) study and provide structure and space for reflection, discussion and learning.  After submission of this form, printed copies of the guide will be provided to the facilitator. Guides are provided at no cost to groups/individuals who live or impact Clay, Platte and/or Ray Counties. Please allow up to 10 days to receive your guides.
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Facilitator's Full Name *
Facilitator's Email Address *
Facilitator's Phone Number *
How did you hear about the Roots of Resilience Action Guide? *
Please tell us a little bit about the group in which you plan to use the Action Guide: *
Which of the following sectors will your Action Guide group involve?  (please select all that apply) *
Required
Which of the following geographical areas does your group live or impact?  (select all that apply) *
Required
When do you plan to convene your group? *
When do you plan on being finished with the guide?  (Remember, there are 5 sections). *
Do you need access to the Resilience film? *
How many Action Guides do you need for your group?  (Action Guide printing is expensive so please consider this question carefully.) *
Will you ensure that the Action Guides are distributed to your group? *
Will you ensure your group members fill out the online evaluation (link provided on page 46 of the Guide) at the completion of the project. *
How would you like to receive your Action Guides? *
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