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* 1. Name (First and Last)

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* 2. Email

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* 3. Phone

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* 4. Age:

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* 5. Gender identity (select all that apply):

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

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* 7. Select which of the following apply:

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* 8. Which event do you plan to attend?

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* 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.

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