Circle Request Form

Circle Request Form

Name*

Northwestern email address*

What roles are present in your group? (Select all that apply)*

Tenure track faculty, but not yet tenured

Tenured faculty

Adjunct faculty

Non-tenure track/clinical faculty

Post-doc

Undergraduate student

Graduate/Professional student

Full time staff

Part time staff

Primary department or unit at Northwestern*

Type of Circle Requested

Select

What restorative topic(s) are you hoping to cover?*

setting shared values and agreements with a group

how does community feel? what do you want to experience in your community?

how do you contribute to the community that you want to see?

when do you show up as your full self? when do you choose NOT to bring your full self to a space?

when/where do you experience the deepest sense of connection?

what is your current comfort level engaging in person and/or remotely with others? where would you like to be?

how do you say hard things and hold space to hear hard things?

celebration of accomplishments

thinking ahead, reflecting on the past

gratitude

empathy

values - what matters to you? how do your values define you?

other

If you selected other for restorative topics, please elaborate.*

What theme(s) might you like to explore in a circle series?

re/establishing effective team dynamics

finding common ground and language for difficult conversations

revealing group strengths and shared goals

holding space to unpack team retreat themes and action items

other

If you selected other for series theme(s), please elaborate.*

Do you have a specific timeline in mind?

Please provide a brief description of your group, what you are looking to get out of a restorative community building circle, and anything else you feel is important for us to know.*

Send me a copy of my responses

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