* 1. Name (optional): 

* 2. Email (optional):

* 3. What is your age?

* 4. With which gender do you identify?

* 5. With which race and/or ethnicity do you identify?

* 6. What is the highest level of education you have completed?

* 7. In what ZIP Code do you live?

* 8. Whose table did you join, and where did you meet?

* 9. Did you meet someone new at your table?

* 10. What was the most encouraging topic discussed at your table?

* 11. What was the most challenging topic discussed at your table?

* 12. Did issues of race and/or racial equity come up at your table?

* 13. Which idea do you think has the most potential to have a positive impact in our community?

* 14. After participating in your conversation(s), do you better understand how you personally can help address the issues facing our community?

* 15. After participating in your conversation(s), do you feel more motivated to work with others to have an impact in our community?

* 16. I made specific plans to work with one or more people at my table.

* 17. How did you hear about On the Table?

* 18. How could we make On the Table better?

* 19. Would you participate in On the Table again?

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