#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.

Question Title

* Organization Type

Hospital

Health System

Question Title

* Please provide your organization's contact information.

Organization Name

Primary Contact Name

Primary Contact Email

Primary Contact Phone

Question Title

* 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)

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.

Question Title

* In a few sentences, describe your organization’s progress towards the selected goal(s) above.

Question Title

* Can you share what you feel is a key success factor for advancing this work?

Question Title

* Is there something in the process or work you would change if you could go back?

Question Title

* 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

Question Title

* 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.