Communities of Practice - Department Heads Sign-up

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* 1. First and Last Name

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* 2. Organization

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* 3. Email Address

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* 4. What is your race? (check all that apply)

White or Caucasian

Black or African American

Hispanic, Latina/o/x, or Spanish Origin

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

I prefer not to say

Other (please specify)

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* 5. Area(s) of Professional Responsibility (check all that apply):

Programs

Communications/Marketing

Operations

Other (please specify)

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* 6. Individuals may be placed into breakout groups based on areas of responsibility. If you cover multiple areas, is there a group you'd prefer to be placed in?

Programs

Communications/Marketing

Operations

No preference

Not applicable

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* 7. What are you hoping to gain from this experience?

Connect with other professionals

Make new friends

Learn from the experiences of others

Find support to feel less alone

I'm not sure what to expect from this group

Other (please specify)

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* 8. I agree to participate in the Community of Practice and abide by the guidelines set forth in the Charter.

Yes

No