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* 1. Name (First and Last)

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* 2. Best phone number to reach you at:

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* 3. Email address (personal)

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* 4. Your workplace:

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* 5. Your occupation:

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* 6. Are you any of the following?

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* 7. Have you attended any of the following?

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* 8. Have you attended any of the following SEIU educational courses?

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* 9. Have you applied for the 2019 Summer School?

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* 10. Do you identify as any of the following equity seeking groups?

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* 11. I can listen to and put myself in others' position and see things from their point of view as well as productively talk about bias and differences.

Never Sometimes Always
i We adjusted the number you entered based on the slider’s scale.

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* 12. I am aware of how systemic inequities, exlusion and oppression directly impacts colleagues, patients/clinets, family, friends and others as well as on myself

Never Sometimes Always
i We adjusted the number you entered based on the slider’s scale.

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* 13. I understand the need for and impact of organizational policies and practices that support diversity, equity and inclusion and I work to put those policies in place.

Never Sometimes Always
i We adjusted the number you entered based on the slider’s scale.

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* 14. What are some of the specific issues that you have personally experienced around issues of discrimination in the workplace?

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* 15. If you were consulted by your employer or union to provide input on solutions around discrimination in the workplace; what would some of these solutions be?

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* 16. Are incidents of discimination becoming more prevasive over the years, or do they remain relatively the same?

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* 17. If you had to point to specifics, what would you say are some the major causes of discrimination in your workplace?

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* 18. I prefer that when we have conversations regarding equity:

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* 19. My interest in furthering human rights steam from:

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* 20. Part of the Human Rights Conference will include development of action plans. Are you willing to help your union in the workplace and in the community further human rights through campaign and volunteer work?

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* 21. Is there anything else you would like to say?

0 of 21 answered
 

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