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YMCA GA My Interest Survey

GivaGeta helps you make a positive difference in people's lives with fun "Learn By Doing" tools and workshops for character, leadership, family and team development.

___ Metro   ___ Independent   ___ # of locations of each
___ Afterschool Programs  ___ Preschool     Camp   ___ Day   ___ Resident
___ # On Site Locations ____
___ Other initiatives/programs, i.e. Achievers, Girls On The Move, Teen Group ______________

What is your fiscal year  ___ Calendar   ___ July  ___ other

What is your interest?

1. ___ Getting kids attention to engage them to teach them
2. ___ Get kids to interact and teach how to get along
3. ___ Developmental Asset Building (check if want to be ___ Intentional)
   Teaching Caring, Honesty, Responsibility & Respect in a fun filled way
   Teaching Kindness, a Positive Attitude, Teamwork, Appreciating Diversity and more positive values in a fun filled way
4. ___ Character Development (check if want to be ___ Intentional)
5. ___ Leadership Development
6. ___ Team, Staff and/or Board Development ___ that transfers onto the kids
7. ___ Strengthen: ___ Families ___ Teams ___ Boards ___ Communities
8. ___ Fundraising
9. ___ Getting someone to pay for this
10. ___ Proactively Reducing Emotional Bullying
11. ___ Peer Mediated Conflict Resolution
12. ___ Portable, Self Directed Free Time Activities
13. ___ Ice breakers, Mixers, Conversation Starters, Opening & Closing Activities
14. ___ Getting Good Free Press
15. ___ On Site Training ___ Train the Trainer ___ Team Building Workshops ___ Other
16. ___ Measure Results
17. ___ Other interests______________________________________________________________
18. ___ A way to ask for increased sponsorship levels to support our initiatives. ie Developmental Assets. The intiatives I would like to support are: _______________________________________________________________

Contact info                    Name                    Position                    Tel                    Email
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________

Follow up time frame:  ___ 1 week  ____ 2-4 weeks ___ Sept ___ Oct ___ Nov ___ Dec ___ Jan 2011 ___ Other