ࡱ > W [ V bjbjcTcT ;" > > * " " / / / / / / / / 8 0 $ 70 , / O c0 ( 0 0 0 0 )2 )2 )2 >O @O @O @O @O @O @O 'R T L @O / )2 )2 )2 )2 )2 @O / / 0 0 UO 3 3 3 )2 X / 0 / 0 >O 3 )2 >O 3 3 K D N 0 @Dd / 2 d BM & *O kO 0 O hM " V 2 V L N V / N )2 )2 3 )2 )2 )2 )2 )2 @O @O 3 )2 )2 )2 O )2 )2 )2 )2 V )2 )2 )2 )2 )2 )2 )2 )2 )2 " . : Community Conversation Summary Template
Use this template to record the major topics and ideas discussed during the Community Conversation.
Within 1 week of the event, the convener should
Download the electronic copy of the summary template, available at: HYPERLINK "http://www.atsdr.cdc.gov/nationalconversation/community_conversations.html"http://www.atsdr.cdc.gov/nationalconversation/community_conversations.html.
Fill out the summary template using the notes from the meeting.
Send the summary to HYPERLINK "mailto:nationalconversation@cdc.gov"nationalconversation@cdc.gov. All summaries are due by June 30, 2010.
Convener contact information:
Name: ____________________________________
Email address: _____________________________
Phone: __________________________
Address:__________________________________
_________________________________________
Convening organization(s) (if applicable):__________________________________ ___________________________________________________________________
Meeting location (city, state): _______________________________
Meeting date: __________________
Number of participants: ______
Brief description of participants and community:
Topic 1: Concerns
Participants main concerns included:
Participants disagreed on whether to be concerned about certain issues, including:
Topic 2: Values
List several values that participants thought were important:
Topic 3: Roles and responsibilities
Participants noted key steps that certain groups could take, including:
Topic 4: Learning from accounts of success and failure
The main lessons we can learn from the discussion of successes and failures include:
Follow up
Did the group make any plans for a follow up meeting about local action?
Please list the email addresses of participants who noted on the sign-in sheet that they want to receive National Conversation updates.
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