Penumbra Theatre Equity Workshop Intake
  
 
Organizational Information 
 
1.

Organization: 

 

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2.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com

3.
Type of Organization: 
Corporate
School
Nonprofit
Government
Legal/Law Enforcement
Other  
4.

Preferred date of workshop: 

 

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5.

Preferred length of workshop:  

1.5-2 hours
3 hours
Half-day
Full-day
Other  
6.

Number of participants: 

 

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Demographics of the group:
 
7.
Racial makeup: 
 

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8.

Gender makeup: 

 

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9.

Roles within the organization:

 

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Goals of the workshop: 
 
10.

What has prompted you to consider hosting an Equity Workshop?

 

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11.

What do you hope the participants will get out of this session? Select all that apply:

Gain a better understanding of how to think and talk about race
Increase inclusion, safety and wellbeing of all members of our community
Develop/bolster cultural competency
Develop skills to intervene in racist behavior, practices and policies
Analyze structures of racism and its historical, social, political and economic impact
Increase self-reflection and empathy to support a personal journey of anti-racism work
Cultivate responsibility, accountability and action to change systems of oppression
Encourage recruitment/retention of employees of color
Address a recent incident within my organization
Address the social/political tenor of the community, state, nation
Change how I/we interact with others
Build a sense of team
Diversity/inclusion programming
Other  
12.

How does this fit within the mission of your organization/department? 

 

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13.

Does this fit into any other professional development you are doing? 

 

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14.

Have you done racial equity work with your group before?

None, we want to begin
A little bit, we have a basic framework or understanding about race and racism
Some, we feel competent and are looking to increase knowledge and skills
A great deal, racial equity is part of our mission; we are deeply committed to this work
Other  
15.

What has brought you to Penumbra for this work? (Why Penumbra instead of another organization?)


 

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16.

Anything else you would like us to know as we plan for the session?


 

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