Consultation Assessment


Your info:


Full Name (required) Email (required) Phone (required)
Current City and State Name of Dojo Dojo Web Site

Your position at this dojo (Dojo-cho, owner, student, etc.)

Referred by:

 friend Google search Other

 Other:

Requesting consultation in the following areas:

(To choose more than one, hold down the command key while clicking.)

Experience in the nonprofit sector? Yes No

Dojo profile:

How many dojo members do you have in each of the following age groups?

  • Dojo members age 3-11
  • Dojo members age 12-19
  • Dojo members age 20-34
  • Dojo members age 35-44
  • Dojo members age 45+

Describe your dojo now and or your reason for contacting me.

Describe your dojo in a perfect world. What is your dream?

Anything to Add...?

Attach Document? (optional) (For Example, dojo pamphlets and literature, etc.)

Attach Other Document? (optional)