Collegiate EmPowerment
Pre-Consultation Questionnaire

Thank you for your interest in Collegiate EmPowerment. We look forward to having the opportunity to serve you. In order to assist you with your programming needs, we would like to arrange a phone appointment with you to speak with one of our Collegiate EmPowerment Consultants. Please let us know what date and time works best for you. We will be certain to confirm the appointment with one of our Collegiate EmPowerment Consultants with you via email.

The purpose of the phone appointment will be to conduct a Collegiate EmPowerment Consultation so we can gain a better understanding of your needs and help to determine how we can best serve you. To make the most of the call please provide us with some general information about you and your upcoming event:

Name:
School / Organization:
Position:
Phone Number:
Email Address:
Best Date and Time to Call:
What Collegiate EmPowerment Services are You Interested In:
 
Student Seminars
Professional Development
Products and Tools
How did you hear about us?
What is your tentative date and time?
Is there a core topic/content focus you are looking for?
When it comes to speakers what is most important to you?
When it comes to speakers what is your greatest frustration?
What is your budget for the event/speaker?
What is the "one thing" you want your students to walk away with following the presentation?

Thank you once again for your interest in Collegiate EmPowerment as we look forward to Helping You Take Higher Education Deeper!