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* 1. What is your gender?

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* 2. What is your age?

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* 3. What is your current rank/title?

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* 4. What is your specialty?

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* 5. Please specify your race and ethnicity (check all that apply)

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* 6. Please select the level of importance (1 being most important) of the goals you would like the SUS JEDI Committee to work on:

  1- Very Important 2-Important 3- Neutral 4- Unimportant 5- Very Unimportant
Diversity in SUS membership applicants by encouraging membership from under-represented populations
Diversity and inclusion in SUS committees
Partner with other societies (representing URMs) to promote their members and URMs in academic medicine
Development of a Diversity, Equity and Inclusion Course similar in format to the SUS Mid-career and AAS Fall courses in conjunction with the AAS EDI Committee
Development of Awareness Campaigns Tools that institutions can use locally
Promote and help further develop Career Development activities such as the SUS Promising Leaders Program
Response to social injustice events as an organization

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* 7. Please list any other actions you believe would be critical for the SUS JEDI committee to prioritize and work on.

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* 8. What steps can the SUS JEDI Committee take to ensure all surgeons who qualify feel welcome to apply for SUS membership? Check all that apply.

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* 9. In light of current events, in general please select the level of importance/significance (1 being most important) in your opinion:

  1- Very Important 2-Important 3- Neutral 4- Unimportant 5- Very Unimportant
Systemic Racism
Gender Equity
LGBTQ+ Rights

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* 10. In what ways can the SUS be more inclusive?

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* 11. Is it okay for the SUS JEDI committee to contact you for further discussion about any of the above questions?

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* 12. If yes, please submit your name and the best way to contact you.

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