Philanthropy Racial Equity Roundtable 4.0 Application

General Information

25% of survey complete.

Question Title

* 1. Organization Info

Institution Name

Organization Address (including City, State and Zip Code)

Phone Number

Website

CEO/President/Executive Director

Annual Operating Budget/Revenues

Question Title

* 2. Primary Staff Contact for Racial Equity Roundtable

Name

Title

Phone Number

Email Address

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* 3. Racial Equity Roundtable Participants

Name

Title

Email Address

Name

Title

Email Address

Question Title

* 4. Substitute Participant(s)

Name

Title

Email Address

Name

Title

Email Address

Question Title

* 5. Mission Statement or Business Purpose

Question Title

* 6. Institutional Type (Check Primary Category)

Corporate or For-Profit Business

Nonprofit (Service Provider)

Government or Public

Philanthropic/Grantmaker

Health Institutions

Pre-K to 12 Education

Higher Education

Other (please specify)