Request for a Facilitator  

(Instructions:  click on Edit, Select All, Copy, Paste into email message, fill out form, email to:  mfn@mnfacilitators.org)

Name & title of requestor:

Email:

Phone:

Name of organization needing a facilitator:

Relationship of requestor to organization:

Describe members of the group to be facilitated:

Describe issue, problem, concern group needs to address & expected outcome:

Describe the type / style of facilitation group expects or desires:

Describe special requirements / requests to be met:

List possible dates and times the facilitator is needed:

Identify the city, state and facility for this group facilitation: