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#123forEquity Goals Update Form
Thank you for taking the
#123forEquity pledge
! Please share your story and provide a brief update about your organization's work to achieve each of its selected pledge goals.
*
Organization Type
(Required.)
Hospital
Health System
*
Please provide your organization's contact information.
(Required.)
Organization Name
Primary Contact Name
Primary Contact Email
Primary Contact Phone
*
Please select the pledge goal(s) that your hospital and/or health system has committed to working on related to inclusion, diversity and equity in health and health care. (Select all that apply)
(Required.)
Increase the collection and use of race, ethnicity and language preference data
Increase cultural competency training
Increase diversity in governance and leadership
Improve and strengthen community partnerships
Please share your organization's health equity journey below.
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In a few sentences, describe your organization’s progress towards the selected goal(s) above.
(Required.)
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Can you share what you feel is a key success factor for advancing this work?
(Required.)
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Is there something in the process or work you would change if you could go back?
(Required.)
As a reminder, your organization's individual data will be kept confidential. However, if you are willing to share your organization's story with the field, please check all the ways that you would be interested in presenting it.
Webinar/Podcast
Article/Blog Post
Case Study
Social Media
Please check here to receive a copy of your answers.
Yes, please email a copy.
Recipient(s) Email - Please separate multiple emails with a semicolon (;)
For assistance with or questions regarding the pledge, please email us at
equityofcare@aha.org
.
