First Name *
Last Name *
Email *
Phone Number *
Organization
County *
- Select a Value - Allen Anderson Atchison Barber Barton Bourbon Brown Butler Chase Chautaqua Cherokee Cheyenne Clark Clay Cloud Coffey Comanche Cowley Crawford Decatur Dickinson Doniphan Douglas Edwards Elk Ellis Ellsworth Finney Ford Franklin Geary Gove Graham Grant Gray Greeley Greenwood Hamilton Harper Harvey Haskell Hodgeman Jackson Jefferson Jewell Johnson Kearney Kingman Kiowa Labette Lane Leavenworth Lincoln Linn Logan Lyon McPherson Marion Marshall Meade Miami Mitchell Montgomery Morris Morton Nemaha Neosho Ness Norton Osage Osborne Ottawa Pawnee Phillips Pottawatomie Pratt Rawlins Reno Republic Rice Riley Rooks Rush Russell Saline Scott Sedgwick Seward Shawnee Sheridan Sherman Smith Stafford Stanton Stevens Sumner Thomas Trego Wabaunsee Wallace Washington Wichita Wilson Woodson Wyandotte

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• Planning Team: Please describe your planning team. A successful data walk starts with the planning team. We recommend exploring collaboration with other community leaders and organizations who can contribute to the planning and putting on the event.
• Goal: What are you hoping to accomplish by hosting a data walk?
• Audience: Who is your audience? Who can shape the conversation and lead action in your community?
• Which of the following data walk formats are you considering? Select all that apply:
  Data Walk Event: These are typically larger community events that bring together community leaders. Participants interact with the data and have conversations about what the data mean and how to take action. Event Component: Data walks can be embedded into existing events or gatherings, like a conference. As event components, data walks can be used as a level-setting tool to inform participants about the issue and prep them for later conversations. Meeting or Classroom Activity: Data walks can be integrated into a meeting or classroom activity. Data walk posters can be used to engage students or participants in learning about data, as well as create an avenue to generate ideas. Other. Please describe below:
• Other
Preferred Material Pickup Date:
Preferred Pickup Location:
Topeka Wichita Either Topeka or Wichita
• Please include any additional information you think would be helpful for us to know when considering your request.

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