Access, Equity, and Inclusion: Feedback Form Survey

1.Your Contact Information (Optional)

First Name:

Last Name:

Email Address:

Phone Number:

Zip Code:

Organization (if applicable):

2.Which of the following best describes you? (Choose as many as apply.)

Other (please specify):

3.Are you a member of a marginalized group or community?

Yes

No

4.Please share your thoughts or feedback:

5.Overall, how are we doing with our access, equity, and inclusion work? Please rate us, with 5 stars being the best.

Other (please specify):