CONNECT Experience Assessment Form

Primary Contact Name*

First Last

Primary Contact Email*

School/Organization Name*

School/Organization's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact's Cell Phone Number*

Estimated number of participants. We can serve 10 to 100 participants.*

Please enter a number from 5 to 1000.

Participant Grade(s)*

For a large group experience (over 40 participants), we will present to your team & teachers 1-2 weeks prior to the scheduled experiences to support a meaningful and enjoyable experience for everyone. What dates are preferable for the presentation? Use N/A if this does not apply to your experience.*

Please list the dates in the format of mm/dd/yy, mm/dd/yy if more than one date

Please let us know the desired location and preferred date(s) for each experience.*

Please list the dates in the format of mm/dd/yy

Please select from below. Note: All CONNECT experiences include stronger relations through team building, fine tuning critical thinking skills, proficiency in active listening and increased empathy & respect for differing perspectives.*

For online experiences, is Zoom or Microsoft Teams compatible for your students Bridge Builders learning experience?

Please describe the dynamics of your group:*

What is the ultimate goal for your group?*

Bridge Builders can often make adaptations to activities to include all participants. Do you have students who will need accommodations to participate? This includes physical, intellectual, and mental health supports.

If yes from above please explain.

CONNECT Assessment Form

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