2024-25 Racial Equity Roundtable Application

General Information

Thank you for your interest in the upcoming Racial Equity Roundtable cohorts!

The three-hour sessions will take place one Friday morning a month, beginning October 2024 and ending May 2025. Specific dates will be determined as cohort rosters are confirmed.

We look forward to learning and advancing positive change with you.

20% of survey complete.

Question Title

* 1. Organization Info

Institution Name

Organization Address (including City, State and Zip Code)

Phone Number

Website

CEO/President/Executive Director

Annual Operating Budget/Revenues

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* 2. Primary Staff Contact for Racial Equity Roundtable

Name

Title

Phone Number

Email Address

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* 3. Racial Equity Roundtable Participants

Name

Title

Email Address

Name

Title

Email Address

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* 4. Substitute Participant(s)

Name

Title

Email Address

Name

Title

Email Address

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* 5. Mission Statement or Business Purpose

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* 6. Institutional Type (Check Primary Category)

Corporate or For-Profit Business

Nonprofit (Service Provider)

Government or Public

Philanthropic/Grantmaker

Health Institutions

Pre-K to 12 Education

Higher Education

Other (please specify)

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* 7. Please choose your org's preferred cohort type (you may choose up to 2):

Cross-Sector (various institutional types)

Health Systems

Arts & Culture