Priority (check one)

	A – I need help from the group today (degree of urgency as well as importance)
	B – This can wait til next month and/or I have other resources for assistance
	C – This can wait and it’s not that important; nice to get to if time
	D – I don’t plan to bring this to the group at this time because __________________

Kind of help I believe I need from Vistage: (check one or more)

	Thought partner(s) with whom to dialogue
	Identify where I’m struggling or stuck
	Validate my planned actions
	Challenge my planned actions
	Hear and empathize with my feelings (non judgmental support)
	Clarify action steps to take in next 30 days
	Hold me accountable
	Other ___________________________________

Who do I need assistance from in this group? (check one or more)

	121 with Gil
	121 with other member: _________________-

mini board (2 –3 other members often work with)

	small group (5 – 8 other members – random or topic selection)
	full group (I need the widest range of experience and perspectives – and/or belief that majority will give/receive value from discussion)

	Vistage View  library and best practices
	Other: ___________________________________

What do I need to prepare to optimize the time we spend on this? Topic worksheet; background data – Anything to provide ahead of time?

Notes (including date and status):