Election 2012 Summary Form

April 26, 2012

Location of Event (City, State):                                               Date:

1a. List 3 or 4 things that surfaced in your discussion as things that need to be addressed:

1b. What government (elected officials) should do to address the needs and promote the common good:

1c. What you, the people, will do:
2. Short description of the group and the demographics (e.g. ethnicity, gender, age, religious affiliation, etc.) and any comment about who was missing from the group: (please also attach your sign-in sheet with mailing and email addresses)

3. Any comments people had about participating in this dialogue process, or feedback about leading or participating this dialogue: