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1. Are you answering on behalf of yourself or an organization/group?

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2. If the latter, what organization/group?

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3. Zip Code

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4. What is the specific problem related to racism that needs to be addressed?

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5. What strategy/ies do you suggest will address this problem?

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6. Who do you think is best to lead this change?

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7. What can you pledge to do to support positive change?

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8. Do you have a personal experience/observation that demonstrates the problem you shared above?

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9. Are there any other comments / questions you would like to share?

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