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* 1. Name:

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* 2. Organization:

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* 3. Job title:

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* 4. Phone Number:

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* 5. Email Address:

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* 6. Tenure at Organization:

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* 7. Tenure in Nonprofit/Philanthropic Sector:

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* 8. Racial Identity:

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* 9. Gender Identity:

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* 10. Can you commit to a year-long working group membership, attending 4-6 meetings a year? We will be flexible with timing to adapt to members’ schedules.

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* 11. What is driving your interest in joining the Racial Equity Working Group? What makes this group relevant to you right now? What do you hope to gain? Please use no more than 250 words.

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* 12. Outside of PNY programming, which racial equity trainings have you participated in and in what year?

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* 13. Please share the areas in which you are looking to make practice shifts in service to equity. You may check all that may apply. 

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* 14. Does your organization currently have any institutional policies or practices around equity and inclusion?

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* 15. Please describe the scope of your role(s) within your organization and what authority, authorization, and/or ability you have to promote broader organizational change. What challenges do you anticipate? Which allies might you organize with? And, what resources might you mobilize? Please use no more than 250 words. 

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