Diversity, Equity, Inclusion and Belonging Committee (DEIB) Committee Application

The DEIB Committee is seeking to identify a wide array of individuals to serve as committee members. To help us in this effort, please answer the following questions:

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* 1. Please provide the following information:

First name

Last name

Department

Division

In 4-6 sentences, please answer the following questions about your interest in joining the DEIB Committee:

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* 2. Why do you want to join the DEIB committee?

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* 3. What specific skills and/or perspectives will you bring to the committee?

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* 4. What kind of DEIB initiatives do you think are important for this committee to work on?

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* 5. What is your age group?

18 – 25

26 – 50

50+

Prefer not to answer

Other (please specify)

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* 6. What gender do you identify as?

Female

Male

Nonbinary

Prefer not to answer

Other (please specify)

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* 7. Do you identify as a member of the LGBTQ community?

Yes

Prefer not to answer

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* 8. *Please specify if you identify with one of the following racial or ethnic groups:

White

Black or African American

Latinx/Latino/Latina or Hispanic

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaskan Native

Two or More

Prefer not to answer

Other (please specify)

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* 9. Do you speak another language other than English? If so, please specify.

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* 10. What is your parental/family status and/or do you have adult dependents? (Check all that apply)

Children under the age of 18

Children over the age of 18

Adult dependents

No children

Prefer not to answer

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* 11. Do you live in Marin County?

Yes

Prefer not to answer

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* 12. How long have you worked for the City?

Less than a year

1 – 2 years

2 – 5 years

5 – 10 years

More than 10 years

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* 13. Do you identify as a person with a disability or a person who is neurodiverse?

Yes

Prefer not to answer

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* 14. Which office location in the City is your home base?

City Hall

Community Center

Library

Childcare

Department of Public Works

Public Safety Administration

*For purposes of this application, definitions of racial and ethnic groups are defined as follows:

American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the Black racial groups of Africa.

Latinx, Latino, Latina or Hispanic - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino."

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.