Middletown Community Coversations, Sample Questions and Response Form

Middletown Community Conversations

Sample Questions and Response Form

Several groups have asked for example facilitating questions with which to start their community conversations as well as an example of a response form to report out their conversation results.

Sample Questions

The following are two sets of three questions we found helpful.

What important issue or idea was brought to mind by the Inaugural Address?
What can we, as a community, do about it?
What can you as an individual do about it? If “yes we can”, then what will I do?
Related to what will “I do”, what can we do together?
What resources do we need to make this happen?

Conversation Reporting Form

If you do not use this form, when you report back, please be sure to include:

group/organization involved
location
date
time
number of participants.

This information should be forwarded to Justin Carbonella at either his e‐mail address:

carbonellaj@mps1.org

Or mailed to:

Justin Carbonella
Middletown Youth Services Bureau
370 Hunting Hill Avenue
Middletown, CT 06457

Middletown Community Conversations Held

by(organization):_____________________________________________________
on (date & time) ____________________
at (location)_________________________________
for (# of people)______________

For each of the topics discussed, please report out topics noted below. For example, the issue is picking up after your dog; group solution might be install pooper scooper bag kiosks and signs as well as submit grant application to dog food companies for signs and kiosks; individual solution might be pick up after your own dog and encourage family and friends to do the same; resources would be signs and kiosks.

Issue (please relate to Middletown): ____________________________________________________
____________________________________________________
____________________________________________________ ____________________________________________________

Solutions: What can we do? ____________________________________________________
____________________________________________________ ____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

What can I do?__________________________________________
____________________________________________________ ____________________________________________________

Resources needed (if any):_________________________________________________
_____________________________________________________


Issue (please relate to Middletown):
_____________________________________________________
_____________________________________________________ _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Solutions: What can we do? _____________________________________________________
_____________________________________________________ _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

What can I do?___________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Resources needed (if any)__________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________