Thank you for your interest in our organizational assessment. Please enter the following information and we will be glad to provide you with a quote (usually within 3 business days). If you have any questions about how to fill out this form please contact us and we will be glad to walk you through the questions.

First Name
Last Name
Phone number(s) - Ex. 614-432-8899 work, 614-458-9952 cell
E-mail address
How do you prefer to be contacted?
Your Organization's Name
Your Organization's Website
Your Role with the Organization - Ex. Pastor, Vice President for Student Life, Administrator
Your Department (if applicable) - Ex. HR, Community Service, College Ministry
Your phone number
SURVEY PERIOD
What dates would you like the survey to be available online for people in your organization to fill out? We typically recommend a period of 10-30 days.
Starting Date: Ex. 6/1/13
Ending Date:

RESULTS AVAILABILITY
The results will be available online for one month after the survey period is over. Of course, you are welcome to print or save the results for your records.

PRICING POLICY
 The survey can be used by up to 200 people for only $100! We charge 50 cents for each additional person. That way you are only charged for the people who actually use the survey. We ask that you initially pay $100. Then, if you have more than 200 people use the survey we will send you an invoice for the additional amount (50c for each person over 200) which we ask that you pay within 30 days.

Please initial here if you agree to the pricing policy:
(required)

How many people do you estimate will use the survey in your organization?


ADDITIONAL OPTIONS
The approximate additional cost for each item is shown in parenthesis.

Description Interested Not Interested
Each individual survey entry that is submitted can be immediately e-mailed to an address that you specify. ($25)
You can e-mail us your logo and we will add it to the top of the survey and the summary report. ($25)
You can customize the survey questions and groupings (leader, member, majority, minority, etc.) to be a better fit for your organization's needs. You let us know the changes you would like and we will customize the survey and results summary. ($50)
One or more of our experienced training facilitators can study your results and then present you with their observations and recommendations for next steps through a 1-2 page written summary or a one hour phone conversation. Please specify which presentation method you prefer below. ($200)

Clarifications or Questions:


Discount Code:


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