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THCU Consultation Planning Form

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Consultant	Nancy Dubois Heather Graham Larry Hershfield Robb MacDonald Jodi Thesenvitz *
Date of Request
Parent ID #
First Name	*
Last Name	*
Organization
Email	*
Anticipated Timeframe for Consultation
# of People Participating in Consultation

 

Nature of the consultation (Description of Request)
Desired outcomes (check all that apply)
	Program Specific
	Reach consensus on program/service priorities
	Plan and implement a situational (needs) assessment
	Develop goals and objectives to guide program planning/evaluation
	Develop indicators of success to guide program planning/evaluation
	Create program plan/logic model
	Develop a health communication campaign
	Develop a media advocacy campaign
	Create a health promoting policy
	Produce a program sustainability plan
	Design a program evaluation
	Organizational
	Build team capacity
	Increase organizational support for work
	Reduce barriers to achieving desired outcomes (please elaborate if necessary)
	Other (please specify)
	Other (please specify)
	Other (please specify)
	Other (please specify)
	Other (please specify)

 

Broad design of guided process consultation sessions

1. What is the history, context, background reason for the consultation?

2. What do you hope to achieve?

3. Who will be attending?

4. How many (locations, background)?

5. Most important, what do they have in common, how are they working together on projects, how well do they know each other?)

6. What are the group dynamics in terms of task and process skills? Any particular people with strengths or limitations to be aware of?

 

Design of next event / meeting

1. For design, which major steps (from one of our planning models) are important? Least important?

2. Within the topic, which sub-steps or other aspects are most important, least important?

3. Length of session(s) ? Dates? Start time? Finish time?

4. What are the best methods? How structured, formal? (Could use structured decision-making tasks such as dotmocracy, “right brain” methods, vignettes/scenarios to choose from)

 

Logistics

1. Room, AV requirements, who and when will room be set up? (Contact person and phone number for location)

2. Which materials, which photocopied, paid by whom?

3. Facilitator travel, directions or map, payment?

4. Accomodations: where, who makes reservation?

5. Meals. What are the arrangements? Where (in room, nearby, at a distance).

 

Next Steps

1. Identify next action steps, roles, deadlines

 

Proposed Workplan
Work Step	Responsibility
	Responsibility --- Nancy Dubois Heather Graham Larry Hershfield Robb MacDonald Jodi Thesenvitz Other: Client: Completion Date
	Responsibility --- Nancy Dubois Heather Graham Larry Hershfield Robb MacDonald Jodi Thesenvitz Other: Client: Completion Date
	Responsibility --- Nancy Dubois Heather Graham Larry Hershfield Robb MacDonald Jodi Thesenvitz Other: Client: Completion Date
	Responsibility --- Nancy Dubois Heather Graham Larry Hershfield Robb MacDonald Jodi Thesenvitz Other: Client: Completion Date

 

Client Contribution (check all that apply)
	Photocopying
	Transportation for consultant
	Accommodation for consultant
	Other (please specify)

 

Notes

 

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