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* 1. What is your gender? 

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* 2. Which category below includes your age? 

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* 3. How do you identify your race and ethnicity? (Please do include nationality, heritage and culture, if desired)

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* 4.  Sexual Orientation (optional; choose all that apply):

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* 5. Which of the following categories best describes your employment status?

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* 6. My field of work contains a diverse population whose backgrounds, beliefs and experiences are different from my own.

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* 7. Getting to know people with backgrounds, beliefs and experiences different from my own has been easy in my current field of work.

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* 8. My current field of work provides an atmosphere for the free and open expression of ideas, opinions and beliefs.

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* 9. I am aware of educational programs and/or resources that promote diversity, equity and inclusion in the workplace.

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* 10. If desired, please explain your experience regarding Diversity and Inclusion in IONM?

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* 11. If you are interested in participating in a more in-depth interview on your experiences in Diversity and Inclusion in IONM, please submit your name and email address.

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