Survey Monkey Sacred Ground Survey

Thank you for your interest in exploring more about being a participant in the Sacred Ground program of the Episcopal Church. As we plan to initiate a Dialogue Circle(s), you will be joining thousands of others across the church working together to raise awareness about, and learning ways to take action against, systemic racism in our society.

Your completion of this survey will help us to form a Dialogue Circle, or circles. Your answers will only be seen by the clergy.

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* 1. **Contact Information (please fill out a separate survey for each person in the household who would be interested in participating in a group)**

Name:

Email address:

Cell Phone/Text:

Profession (if retired or not currently employed, please indicate areas of expertise or community involvement):

Please indicate how you identify racially:

Please indicate if you have friends or family not currently affiliated with St Stephen's who might like to participate in a Dialogue Circle.

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* 2. **Do you have access to any of the following Media Providers? (please check all that apply)**

Netflix

Hulu

Amazon Prime

Kanopy

FaceBook

HBO (Max)

SHO

YouTube

Other (please specify)

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* 3. Which Age Group do you fall into?

14 - 18

19 - 25

25-34

35 - 50

50+

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* 4. Based on the experience of currently running groups, meeting bi-monthly seems to allow the optimal balance for having time to review the materials without losing the momentum of meeting with the group. Participants in the program would need to covenant to meet together twice monthly for 10 sessions (over 5 months or so). Knowing that this frequency is optimal, but may not be realistic for our particular community, please let us know how this would work for you (please check all that apply):

I could commit to meeting for all 10 sessions, bi-monthly.

I could commit to meeting for all sessions, bi-monthly, but know already that I might need to miss one or two sessions.

I would prefer to meet once a month.

I could start meeting in later August.

I could start meeting in September.

I would prefer to join a group later than September.

Additional Comments

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* 5. During COVID, Dialogue Circle meetings would strictly comply with the latest safety guidelines. Please indicate your comfort level with the following:

I would only feel comfortable meeting virtually (by Zoom, FaceTime, etc).

I would feel comfortable meeting in person with the most up to date safety guidelines (e.g. masks, social distancing, outdoors).

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* 6. **Please indicate your comfort level in discussing racial issues (please check all that apply):**

I think discussions about race can be very charged, and I am a little nervous about such discussions.

I think discussions about race can be very charged, and I am very nervous about such discussions.

I have had positive, fruitful experiences with discussions about race.

I have had negative, hurtful experiences with discussions about race.

I have led discussions about race in my workplace, community, church, other setting.

I consider myself fairly new to the discussion about race in our society.

I consider myself fairly well-versed on the discussion about race in our society.

Additional Comments

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* 7. Have you ever felt “different” or marginalized in a group setting because of your race, ethnicity, or perspective? How did this affect you?

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* 8. **Please add any additional comments or considerations for our review as we plan to roll out the Sacred Ground program:**

Thank you for taking this survey and for your interest in joining a Dialogue Circle!

Survey Monkey Sacred Ground Survey

Question Title

* 1. Contact Information (please fill out a separate survey for each person in the household who would be interested in participating in a group)

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* 2. Do you have access to any of the following Media Providers? (please check all that apply)

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* 3. Which Age Group do you fall into?

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* 5. During COVID, Dialogue Circle meetings would strictly comply with the latest safety guidelines. Please indicate your comfort level with the following:

Question Title

* 6. Please indicate your comfort level in discussing racial issues (please check all that apply):

Question Title

* 7. Have you ever felt “different” or marginalized in a group setting because of your race, ethnicity, or perspective? How did this affect you?

Question Title

* 8. Please add any additional comments or considerations for our review as we plan to roll out the Sacred Ground program:

* 1. **Contact Information (please fill out a separate survey for each person in the household who would be interested in participating in a group)**

* 2. **Do you have access to any of the following Media Providers? (please check all that apply)**

* 6. **Please indicate your comfort level in discussing racial issues (please check all that apply):**

* 8. **Please add any additional comments or considerations for our review as we plan to roll out the Sacred Ground program:**