Have you taken part in an Empathy Circle? Your feedback would help us
Email address: [ ]
Name: [ ]
Name of Facilitator: [ ]
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How would you classify yourself politically on economic issues?
Conservative ( )1 ( )2 ( )3 ( )4 ( )5 ( ) center ( )6 ( )7 ( )8 ( )9 ( )10 Progressive
How would you classify yourself politically on social issues?
Conservative ( )1 ( )2 ( )3 ( )4 ( )5 ( ) center ( )6 ( )7 ( )8 ( )9 ( )10 Progressive
I Like: [ ]
I Wish: [ ]
What If: [ ]
Would you take part again? ( )Yes ( )No ( )Maybe
Would you recommend an Empathy Circle to family/friends? ( )Yes ( )No
Would you like to learn how to facilitate an Empathy Circle? ( )Yes ( )No
What do you learn? [ ]
Other Comments: [ ]