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* 1. Name (optional):

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* 2. Email Address (optional):

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* 3. Job Title

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* 4. What kinds of topics/themes related to diversity, equity, and inclusion do you want to learn more about?

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* 5. What kinds of topics/themes would you like incorporated into a group discussion format with other employees?

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* 6. Are there any specific speakers that the committee should engage/invite to upcoming committee meetings? 

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* 7. Are there accessibility needs or accommodations that would support your involvement in the committee? 

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* 8. Are you interested in joining the DEIB committee? 

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