2024-25 Racial Equity Roundtable Application

General Information

Thank you for your interest in the upcoming Racial Equity Roundtable cohorts!

The three-hour sessions will take place one Friday morning a month, beginning October 2024 and ending May 2025. Specific dates will be determined as cohort rosters are confirmed.

We look forward to learning and advancing positive change with you.

20% 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

Question Title

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

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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)

Question Title

7. Please choose your org's preferred cohort type (you may choose up to 2):

Cross-Sector (various institutional types)

Health Systems

Arts & Culture

2024-25 Racial Equity Roundtable Application

General Information

Question Title

* 1. Organization Info

Question Title

* 2. Primary Staff Contact for Racial Equity Roundtable

Question Title

* 3. Racial Equity Roundtable Participants

Question Title

* 4. Substitute Participant(s)

Question Title

* 5. Mission Statement or Business Purpose

Question Title

* 6. Institutional Type (Check Primary Category)

Question Title

* 7. Please choose your org's preferred cohort type (you may choose up to 2):

1. Organization Info

2. Primary Staff Contact for Racial Equity Roundtable

3. Racial Equity Roundtable Participants

4. Substitute Participant(s)

5. Mission Statement or Business Purpose

6. Institutional Type (Check Primary Category)

7. Please choose your org's preferred cohort type (you may choose up to 2):