Organizational Readiness Survey: Preparation for Understanding and Analyzing Systemic Racism

CNM, The Healing Trust, HCA Foundation, and the Dan & Margaret Maddox Charitable Fund are partnering with Crossroads Antiracism Organizing & Training to provide a two and a half day workshop that is meant to help participants transform organizational and personal practices and learn how to create and sustain racially equitable practices. At the end of this workshop, organizations will have practical strategies to implement equitable practices and dismantle racism in their work.

This workshop is designed for teams of four, which can include the CEO/ED, a board member, staff members, volunteers, or anyone else who is associated with your organization. To maximize the opportunity, there will be no more than 11 teams (44 total participants) in the workshop. Scholarships are available on a sliding scale.

If you have any questions, please refer to our FAQ at CNM Equity Offerings. Didn't find what you need? Reach out to Kellee Mannix, Education Director, at kellee@cnm.org.

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* 1. Organization Name

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* 2. Organization Budget (estimated from the most recent fiscal year)

$0 to $49,999

$50,000 to $99,999

$100,000 to $299,999

$300,000 to $499,999

$500,000 to $999,999

$1,000,000 to $1,999,999

$2,000,000 to $4,999,999

$5,000,000 and up

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* 3. Would your organization like to be considered for scholarship to help cover part of the workshop cost?

Yes, our organization is interested in a scholarship.

No, our organization does not need financial assistance at this time.

Other (please specify)

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* 4. Who is the primary contact for this event?

This person will be in communications with CNM about next steps in the process. They may or may not be participating in the session. They will ensure that all team members complete the pre-assignments. CNM will send all communications, including invoices, to this person.

First and Last Name:

Job Title:

Primary Email Address:

Primary Phone Number:

Mailing Address for the Organization:

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* 5. Participant Contact Information

First and Last Name:

Job Title or Role:

Email Address:

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* 6. Participant Contact Information

First and Last Name:

Job Title or Role:

Email:

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* 7. Participant Contact Information

First and Last Name:

Job Title or Role:

Email Address:

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* 8. Participant Contact Information

First and Last Name:

Job Title or Role:

Email Address:

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* 9. Please check the following if your organization is a current grantee. Check all that apply.

Dan & Margaret Maddox Charitable Fund

HCA Foundation

Healing Trust

None of the above

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* 10. Please select your preferred training dates.

August 14, 12-5pm
August 15, 9-5pm
August 16, 9-5pm

December 4, 12-5pm
December 5, 9-5pm
December 6, 9-5pm