*1.Name (First and Last)(Required.)

*2.Email(Required.)

3.Phone

4.Age:

Under 18

18-24

25-39

40-54

55+

5.Gender identity (select all that apply):

Man

Woman

NonBinary

Two-spirited

Transgender

Agender

Genderqueer

I prefer to self-describe

6.Racial/ethnic identity (select all that apply):

American Indian/Alaskan Native

American Indian from South or Central America

Black/African American/ADOS

Asian/Asian American

Hispanic/Latinx

Native Hawaiian/Pacific Islander

White/European

I prefer to self-describe

7.Select which of the following apply:

Minneapolis resident

Non-resident but connected to Minneapolis (via work or other) - please describe

8.Which event do you plan to attend?

South (Longfellow Park Rec Center - 3435 36th Ave S, Minneapolis) - July 7th - 6-8pm

Northeast (Windom Northeast Recreation Center, 2251 Hayes St NE, Minneapolis) - July 10th - 3-5pm

Southwest (Bryant Square Recreation Center, 3101 Bryant Ave S, Minneapolis) - July 21st - 6-8pm

North (North Regional Library, 1315 Lowry Ave N, Minneapolis) - July 24th - 3-5pm

City-wide (Westminster Presbyterian Church, 1200 S Marquette Ave, Minneapolis) - July 28th - 6-8pm

9.What is your industry or what background do you bring to this conversation?

(If you are a member of the press interested in attending, please contact us at info@mnjrc.org)

The Minnesota Justice Research Center (MNJRC) is collecting this information as part of its partnership with the Minnesota Department of Human Rights (MDHR), which enforces the Minnesota Human Rights Act.  

I understand that filling out this form does not mean I filed a charge of discrimination with MDHR. I understand that the information I am providing will be treated as “private data on individuals” under the Minnesota Government Data Practices Act, Minn. Stat. ch. 13, and the Minnesota Human Rights Act, Minn. Stat. ch. 363A.35. MDHR and the MNJRC will use this information to engage a diverse and vast group of community members in Minneapolis directly and gather as much feedback and ideas as possible to help shape a consent decree.
 
I understand that I am not legally required to provide the information I have submitted in this form.