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Trauma-Informed, Resilience-Oriented and Equitable Frontline Staff Community of Practice Application
Part I. Demographic Information
1.
Please enter the following
Name
Title
Phone Number
Email
2.
Please select the category that best describes your racial/ethic background. (Check all that apply)
American Indian/Alaska Native
Asian
Black or African-American
Hispanic, Latino/a, or Latinx
Native Hawaiian or Other Pacific Islander
White or Caucasian
Race or ethnicity not listed (please specify)
3.
Please indicate your personal pronouns
He/Him/His
She/Her/hers
They/Them/Theirs
Prefer Not to Answer
Individually Defined (please specify)
4.
What best describes your role at your organization? (check all that apply)
Executive Leadership/ C-Suite
Management/ Director
Operations Staff
Clinical/Program Staff
Other (please specify)
5.
How many years have you been in your current role?
Less than a year
2-5 years
6-10 years
11+ year
6.
Would you be willing to meet with the evaluation team for an interview at the end of the CoP?
Yes
No
Current Progress,
0 of 18 answered