Action Learning Project
This form can be completed in Word using the tab key to move to each field. Select check boxes with your
mouse or tab and press the space bar. Please limit your responses to 250 words or less. Email your completed
form to email@example.com no later than the due date below. If you have questions, contact Jo Ellen
Carson at 336.723.1002.
Due by August 13, 2012
Submission Date/Revision Date
Community Project Partner (organization):
Complete each response in the space provided. Answers should be brief and well thought out.
1. Provide a brief overview of your organization. Please include your mission statement.
(You may also include brochures of your program or agency.)
2. Check the general category this project relates to, or check “Other” and specify a new
Education Gov’t, Criminal Justice & Human Welfare Social Capital
Arts Health Care Economic Dev
Other (Please describe)
3. Describe the community dilemma, issue or opportunity for the action learning team of
approximately 6-8 people to address: (Cannot be related to fund raising or have a
political or religious agenda)
4. What do you envision as the outcome of this project? Who would be the direct and
indirect beneficiaries of this effort?
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Action Learning Project Proposal continued
5. What are you asking Leadership Winston-Salem participants to do, understanding their
volunteer time commitment is an average of 20-25 hours over the course of approximately
6 months (Nov-May)?
6. As the Community Project Partner, will you be able to make yourself or other key
resources available to the team throughout the project period?
7. As the Community Project Partner, is there anything you would like to share about your
background/interest in this topic?
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