CHNA 17 Racial Equity Learning Community - Question Title * 1. name Question Title * 2. preferred pronouns Question Title * 3. What is your racial or ethnic identity? Question Title * 4. Please use this space to tell us anything else you want us to know about your identity. Question Title * 5. Please check a category that best describes your field government healthcare community based education for profit Other (please specify) Question Title * 6. If you are a service provider, which populations/issues do you serve? Housing/Homeless Substance Abuse Mental Health HIV/AIDS Health Care General Population Older Adults Youth Immigrants Early Intervention Other (please specify) Question Title * 7. organization name (or resident) Question Title * 8. email Question Title * 9. phone number Question Title * 10. role/title Question Title * 11. What are you hoping to get out of your participation in the CHNA 17 Racial Equity Learning Community? Question Title * 12. How would you describe your racial equity experience to date? totally new to this I've done some learning old pro Question Title * 13. What has been your involvement in CHNA 17 to date? Question Title * 14. Have you participated in CHNA 17's Racial Equity Learning Community before? If yes, when? Question Title * 15. Are you interested in being paired with someone from the group to support accountability? Yes No Other (please specify) Question Title * 16. If you are interested in being paired with someone, what is the best way to reach you? email phone Question Title * 17. Do you need any special accomodations? Question Title * 18. Please use this space to tell us anything else we should know. Thanks! Done