Community Action - Circles of Support

ally/participant monthly survey

All Fields with a "*" are required

*Name of person completing this form:
Your Email Address:
I am a/an: Participant Ally

Relationship Building - Does this process enrich your life?
(Please explain)
Appreciation - What have you learned from your Participant/Ally?
Reciprocity - Are you willing to do more and if so, how can we assist?
Mutuality - What are you learning about each other as you build relationship across race and class lines?
Individual Goals - Are you reaching your goals in this process? If not, how can we assist you?

Thank you for filling out the ally/participant monthly survey. Please click on Submit when you have finished.

Engaging our community to end poverty
19 North 21st Avenue West . Duluth, Minnesota 55806
email:mail@communityactionduluth.org phone: 218-726-1665 . tty: 800-627-3529 . toll-free: 866-761-5257