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* 1. Name (Optional):

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* 2. Please pick one of the following:

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* 3. If you're a resident, how long have you lived in Livonia?

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* 4. Do you feel welcome in Livonia?

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* 5. Do you agree or disagree with the following statement: Diversity and inclusion are valued and celebrated in Livonia.

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* 6. Do you agree or disagree with the following statement: Livonia has made progress at becoming a more diverse and welcoming community over the past 5 years?

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* 7. Do you agree with the following statement: There is presently a racism problem in Livonia.

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* 8. I have ___________________________________ racism or racism-related action within the City of Livonia during the past year.

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* 9. During the past year, I have been treated unfairly in the following places in the City of Livonia because of my racial or ethnic background (check all that apply)

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* 10. What form of reporting would you be most likely to use to report racism or racism-related issues?

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* 11. Please tell us your story. Let us know about any experience of racial bias you have had or observed in the city of Livonia.

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* 12. What could the City of Livonia do to make our community a more welcoming and inclusive place for all residents? 

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* 13. Age

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* 14. To which gender identity do you most identify?

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* 15. How would you describe yourself?

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* 16. ZIP Code

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* 18. What is your approximate average household income?

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