Equity Office Participant Demographic Form

Equity Office

Participant Demographic Form

Disclaimer

The Equity Office collects demographic information to inform our planning for inclusive and affirming programming that centers the lived experiences of those most impacted by systems.

Today's Date*

Equity Office Activity*

Please make sure to select the correct activity

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Equity Office Hosted Training*

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City Employee?

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City Department

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Community Organization / Institution

First Name*

Last Name*

Race*

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American Indian & Alaska Native

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Asian

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Native Hawaiian and Other Pacific Islander

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Hispanic or Latino

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Sexual Identity/Sexual Orientation

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Do you identify as Transgender

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Gender identity (select all that apply)*

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Home Zip Code*

Phone Number*

Can we text this number to provide meeting updates

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Email Address*

Age*

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Have you been to an EAT Meeting before?

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Do You Speak a Language Other Than English at Home*

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Other Languages*

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Other Language*

Household Type

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Veteran Status

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Disability Status*

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Do you need additional accommodations?*

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Educational Attainment*

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Have you ever been in an antiracism workshop?*

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Which Antiracism training?*

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Other Antiracism Training

Should antiracism training be a priority in Austin

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Are You A Gatekeeper?*

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What is Race?*

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Racism Equals (=) ?*

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In the context of racism, power is*

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Do you have prejudice?*

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Rate your Understanding of Racism*

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What is your understanding of racism?*

Rate your understanding of the impact of racism*

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Describe impact of racism within your enviroment*

Rate your knowledge of Equity Office framework*

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Rate your knowledge of Equity Office History*

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Rate your knowledge of Equity Assessment Tool*

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Secondary Phone Number

Pronouns*

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I commit to being fully present via video*

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I commit to attend the entire scheduled time*

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I commit to attend a one-hour Post-Training*

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Involved to engage men & boys in ending violence?*

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Tell us about your efforts in ending violence*

In what ways are you looking to grow in that area?*

What brings you to this training? *

What are you hoping to gain?*

How did you hear about this training? *

Please let us know if you have any accommodations*

Is there anything else you would like to share?*

Why are you participating in this training? *

How do you see racism play out in your work?*

How do you see racism play out in Austin Community*

Which Communication Would You Like to Receive?

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Met with Equity Office Staff

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The conversation was supportive

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Send me a copy of my responses

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