POC EJ/CJ Resource Database Survey
Greetings! Welcome to the POC EJ/CJ Resource Database Survey!! The survey below is an effort to compile a referral list of people of color involved in Environmental Justice and Climate Justice in order to facilitate recommending POC in the EJ/CJ movement for certain roles.

Please note that all questions, aside from name and preferred mode of contact, are optional!

We will make this database accessible to the public through our People of Color in Environmental and Climate Justice Resource Persons Website www.pocinecj.org.

We will continue to update the site as we receive more registrants.

Please remember to let us know if any of your information changes over time.

Thank you in advance for completing the survey!

Most Sincerely,
Jacqui

Contact Information
First Name *
Your answer
Last Name *
Your answer
Gender Pronoun(s)
Please mark what gender pronoun(s) you use.
Preferred Mode of Contact *
Required
E-mail
Your answer
Phone Number
Your answer
Location
City
Your answer
State
Your answer
Country
Your answer
Geographic Level of Your Work/Activities/Activism, paid and/or unpaid.
Check all that apply.
Identities
Ethnic/Racial Identity
A friendly reminder that this question is optional.
Your answer
Other Identifier(s)
Ex. Youth, Faith Leader, Mother, Father, Asthmatic, Differently Abled, Fisherperson, Factory Worker, Disaster Survivor, LGBTQI
Your answer
Experience
List the Current Organization(s)/Group(s)/Afilliation(s) you are involved with now, and your Role/Position.
Positions can be paid/unpaid. Please write in format "[Organization/Group/Afillitation]: [Role/Position]"
Your answer
Current Network/Alliance/Coalition Memberships
Please specify if membership is individual or organizational.
Your answer
Areas of Knowledge/Experience
***Please only include areas where you would feel comfortable speaking confidently on.*** For example, if the power goes out and there is no PowerPoint nor any notes! :) (Examples: Just Transition, Gender Justice, Parenthood/Motherhood/Fatherhood, Disaster, Resilience, Energy, Clean Power Plan, Sea Level Rise, Labor/Workers Rights, Trade, Black Lives Matter, Campaign Finance, Corporate Accountability, Human Rights, Emissions Reduction,Agriculture/Food, Water Rights, Land/Housing Rights, Toxics, Voting Rights, Civic Engagement, UNFCCC, Youth Organizing, Public Health, Waste/Recycling, Green Jobs, City Planning, Faith Organizing, Anti-Oppression, Direct Action, Community Resilience, etc.)
Your answer
Skills
Please list the skills about which you feel confident in your ability to execute. Examples-- Communications/Digital Media, Community Organizing, Cultural Work, Facilitation, Mediation, Non-Violent Direct Action, Philanthropy, Policy Analysis, Research, Strategic Planning, Training, Writing, Etc.)
Your answer
Online Bio
Please provide a link to your online bio.
Your answer
Online Resume
Please provide a link to your online resume.
Your answer
Website
If you have a website, please provide the link.
Your answer
Publications/Blogs/Articles
Please list up to 5. Include titles and links.
Your answer
Video Presentation(s)
Please list up to 5. Include the title and links.
Your answer
Preferences for Engagement Requests
Interest in Being Considered for the Following?
Check all that apply
Honoraria Required for Speaking Engagements?
Additional Information & Form Consent
Additional Information/Comments
Anything else you would like to add.
Your answer
Consent to Publicly Disclose Information *
Please confirm permission for all of the information you have shared to be made public. ***Please go back and delete any information that you do not want to be made public***
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