3. FORMS_Where Do We Go From Here -

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CONTACT LJ

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WHERE DO WE GO FROM HERE

We are honored and excited about the possibility of partnering with you for the transformational journey of deepening inclusion and equity that centers racial justice in your organizational culture. Please take some time to respond to this form to the best of your knowledge. This is a way to initiate the possibility of collaboration and work together.

Name of Organization *

Contact Info for the Main Liaison for this Request

Name *

Name

First

Last

Email *

Phone *

Role within the Organization

Information About Your Organization

Mission & Vision (Please share your stated organizational mission, vision and/or values (if you have explicitly created these). *

Size of Organization

Race, Gender and Age Demographics of your Staff *

Additional Information (Please share any other information about your organization that you would like us to know.) *

Equity Work at Your Organization

Your Reason for Reaching Out: (Briefly share what motivated you to reach out for organizational support and training on racial inclusion and equity.) *

What has been done? (Please list, and briefly describe, any previous education and/or work your organization has engaged in related to racial justice or inclusion and equity. (if any) *

Is there a group of people within your organization dedicated to working on equity issues? If so, please briefly tell us about it. *

How would you assess top leadership support and buy-in to move racial inclusion and equity work forward in your organization? (Please select a number between 1 and 5, with 1 being Minimally Supportive, and 5 being Fully Committed.) *

1

2

3

4

5

Please briefly comment on your assessment of top leadership support: *

How would you assess general staff support and buy-in across roles to move racial inclusion and equity work forward in your organization? (Please select a number between 1 and 5, with 1 being Minimally Supportive, and 5 being Fully Committed.) *

1

2

3

4

5

Please briefly explain why you gave the rating above: *

What are some of your expected outcomes as you move racial inclusion and equity work forward in your workplace? *

Please describe the kind of service you are requesting from LJ. (i.e. organizational change support, staff training and development, leadership skill building, equity change consultation, strategic planning, etc. Include information on when you hope the service to be initiated, and the amount of time that your organization anticipates allocating to this work.) *

To what extent has your organization dedicated (or intend to dedicate) adequate and sustainable resources/budget to support equity work? (Include information on when you hope the service to be initiated, and the amount of time that your organization anticipates allocating to this work.) *

Is there anything else you would like to share with us prior to your intake interview? (questions, additional information, initial concerns, etc.) *

If you are human, leave this field blank.

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