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* 1. What does “diversity” mean to you? Please describe in one sentence.

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* 2. What does “inclusion” mean to you? Please describe in one sentence.

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* 3. Which statement best reflects your agency/organization's current diversity and inclusion efforts?

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* 4. How satisfied are you with your organization's diversity and inclusion efforts?

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* 5. If your organization has a diversity and inclusion policy in place, what about it do you think works well? What needs improvement?

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* 6. Please indicate whether you agree or disagree.

  Agree Disagree
My organization publicly communicates information about its diversity and inclusion goals.
Racial, ethnic, and gender-based jokes are not tolerated at my organization.
I am comfortable talking about my background and cultural experiences with my colleagues.
My organization demonstrates a commitment to meeting the needs of employees with disabilities.
My organization handles diversity matters appropriately and demonstrates a commitment to diversity and inclusion.
My organization regularly makes available information about how diverse our employees and leadership team are.
Our leadership team is made up of diverse employees.

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* 7. What do you think is the biggest challenge facing home care and hospice regarding diversity and inclusion?

Demographic Questions

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* 8. What is your ethnicity?

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* 9. What is your age?

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* 10. Do you have a disability? (i.e. Vision, Hearing, Mobility, Cognitive, Other)

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* 11. What is your gender identity?

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* 12. If you would like to be kept in the loop about NAHC's diversity and inclusion efforts, please provide your information below.

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