Black Employee Alliance and Coalition Against Anti-Blackness Membership Form and Registration
Please Complete All Fields
*
1.
What is your name first and last name?
(Required.)
*
2.
Which Department Do You Work For?
(Required.)
311
Academy of Sciences
Adult Probation
Airport Commission
Animal Care and Control
Arts Commission
Child Support Services
Behavioral Health Services
Child support Services
Children and Families Commission
Children Youth and Their Families
City Attorney
City Administrator/GSA
Controller's Office
County Clerk
Controller's Office
Department of Building Inspection
Department of Elections
Department of Disability and Aging Services
Department of Emergency Management
Department of Police Accountability
Department of Public Health
Department of Technology
District Attorney
Disease and Prevention Control
Department of Environment
Environmental Health
Ethics Commission
Film Commission
Fine Arts Museum
Fire Department
General Services Agency
Homelessness and Supportive Housing
Human Resources
Human Rights Commission
Human Services Agency
Juvenile Probation
Maternal, Child, and Adolescent Health
Mayor's Office of Housing and Community Development
Mayor's Office on Disability
Municipal Transportation Agency
Office of Economic and Workforce Development
Office of Financial Empowerment
Police Department
Port
Public Defender
Public Utilities Commission
Public Works
Recreation and Parks
Rent Board
School District
Library
Planning
Airport
Health Service System
Sheriff's Office
Superior Court
Treasury & Tax Collector
Enter department name here if not listed above.
*
3.
Please enter email address here
(Required.)
*
4.
Please enter phone number here
(Required.)
5.
What type of skills do you think you could and would be able to contribute to the Black Employees Alliance and Coalition Against Anti-Blackness?
6.
What is your purpose for wanting to join the Black Employee Alliance and Coalition Against Anti-Blackness
*
7.
Please certify you are completing this form with the intent to become a member of the Black Employee Alliance and Coalition Against Anti-Blackness
(Required.)
Yes
No
Current Progress,
0 of 7 answered