21 Day Racial Equity & Social Justice Challenge Pre-Survey

We appreciate your input so we can build a 21 Day Racial Equity & Social Justice Challenge experience that is supportive and beneficial for all participants. Your answers will remain anonymous and confidential. We will share impact measures after the Challenge with aggregated data to demonstrate reach, demographics, and outcomes.

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* 1. FULL NAME

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* 2. ZIP CODE

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* 3. E-MAIL ADDRESS

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* 4. HOW OLD ARE YOU?

UNDER 18

18-24

25-34

35-44

45-54

55-64

65+

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* 5. HOW DO YOU DEFINE YOUR GENDER IDENTITY?

FEMALE

MALE

NON-BINARY

TRANSGENDER

GENDER FLUID

AGENDER/GENDER-LESS

OTHER:

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* 6. WHAT RACE DO YOU IDENTIFY WITH?

AFRICAN AMERICAN/BLACK

LATINX/HISPANIC

NATIVE AMERICAN/INDIGENOUS

ASIAN/EAST-ASIAN

HAWAIIAN/PACIFIC ISLANDER

WHITE/CAUCASIAN

MIDDLE EASTERN/ARMENIAN/MENA/SWANA

OTHER:

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* 7. WHAT LEVEL OF EDUCATION HAVE YOU COMPLETED?

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* 8. ARE YOU PARTICIPATING IN THIS CHALLENGE AS AN INDIVIDUAL OR WITH AN ORGANIZATION?

INDIVIDUAL

NAME OF ORGANIZATION:

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* 9. HOW DID YOU HEAR ABOUT YWCA GLENDALE'S 21 DAY RACIAL EQUITY & SOCIAL JUSTICE CHALLENGE?

YWCA GLENDALE'S SOCIAL MEDIA

SOCIAL MEDIA PAGES OF SPONSORS OR COMMUNITY AMBASSADORS

NEWSLETTERS OR E-MAILS

FROM A FRIEND

FROM CAMPUS

OTHER:

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* 10. WHAT INSPIRED YOU TO TAKE THIS CHALLENGE?

I WANT TO LEARN HOW TO BE ANTI-RACIST

I AM INTERESTED IN SOCIAL JUSTICE

I SIGNED UP TO TAKE THIS CHALLENGE WITH MY COLLEAGUES/FRIENDS

I WANT TO BRING CHANGE TO MY COMMUNITY

OTHER:

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* 11. WHAT ARE YOUR GOALS AND INTENTIONS FOR YWCA GLENDALE'S 21 DAY RACIAL EQUITY & SOCIAL JUSTICE CHALLENGE?

I WANT TO LEARN ABOUT MYSELF AND MY COMMUNITY

I WANT TO EVOLVE MY WAY OF THINKING

I WANT TO ENGAGE WITH PEOPLE OF ALL DIFFERENT BACKGROUNDS

I WANT TO CHANGE THE WAY I INTERACT WITH MY COMMUNITY

I WANT TO HELP MY EMPLOYER/TEAM ADDRESS THE ISSUES OF ANTI-RACISM AND RACIAL EQUITY

I WANT TO LEARN HOW TO GET INVOLVED WITH ADVOCACY AND MAKING CHANGINGS IN MY COMMUNITY

I WANT TO LEAD OR JOIN IN EFFORTS OF MAKING MY COMMUNITY ANTI-RACIST

OTHER:

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* 12. HOW WILL YOU STAY MOTIVATED TO COMPLETE THIS CHALLENGE?

I AM COMMITTED TO THIS WORK AND LEARNING ABOUT ANTI-RACISM

MY FRIENDS/CO-WORKERS WILL SUPPORT ME TO STAY ENGAGED

I WILL PRACTICE SELF-CARE DURING THIS CHALLENGE

I AM NOT SURE

OTHER:

21 Day Racial Equity & Social Justice Challenge Pre-Survey

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* 1. FULL NAME

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* 2. ZIP CODE

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* 3. E-MAIL ADDRESS

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* 4. HOW OLD ARE YOU?

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* 5. HOW DO YOU DEFINE YOUR GENDER IDENTITY?

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* 6. WHAT RACE DO YOU IDENTIFY WITH?

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* 7. WHAT LEVEL OF EDUCATION HAVE YOU COMPLETED?

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* 8. ARE YOU PARTICIPATING IN THIS CHALLENGE AS AN INDIVIDUAL OR WITH AN ORGANIZATION?

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* 9. HOW DID YOU HEAR ABOUT YWCA GLENDALE'S 21 DAY RACIAL EQUITY & SOCIAL JUSTICE CHALLENGE?

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* 10. WHAT INSPIRED YOU TO TAKE THIS CHALLENGE?

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* 11. WHAT ARE YOUR GOALS AND INTENTIONS FOR YWCA GLENDALE'S 21 DAY RACIAL EQUITY & SOCIAL JUSTICE CHALLENGE?

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* 12. HOW WILL YOU STAY MOTIVATED TO COMPLETE THIS CHALLENGE?

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* 13. IMAGINE YOU HAVE COMPLETED THE FINAL DAY OF THE CHALLENGE. WHAT WILL YOU HAVE ACCOMPLISHED THROUGH YOUR PARTICIPATION? WHAT WILL BE DIFFERENT?

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* 14. HOW CAN YWCA GLENDALE SUPPORT YOU THROUGH THIS CHALLENGE?