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Section 1 of 2
Jackson Pride Inclusivity Survey
Good day! You are being asked to complete this form if you'd like your business/organization to be recognized as one that is inclusive to and friendly toward lesbian, gay, bisexual, transgender and gender-expansive (LGBTQIA+) employees and customers. Those organizations that fill the bill on this Survey will receive recognition in the form of a letter and listing in Jackson Pride's database, for information and referral purpose to people who may be looking for your type of services or products. You will also receive a window cling, small poster or medium "pride flag" (your choice) to display at your business and "proudly" declare your LGBTQIA+ friendly status. 
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Option 1
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David V. Hind
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Title of Person Completing Survey
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Company/Organization Name
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Contact Information: Mailing Address Line 1
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Contact Information: Mailing Address Line 2
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Contact Information: City, State, Zip
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Contact Information: Phone Number
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Contact Information: Email Address
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Please select an industry: 
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1.
Energy/Utilities
2.
Agriculture/Fishing/Forestry/Landscaping
3.
Food and beverage stores
4.
Textiles and apparel
5.
Banking/Insurance/Investing/Capital Markets
6.
Real Estate
7.
Metal Processing
8.
Construction, Home Renovation, Construction Materials
9.
Aerospace & Defense
10.
Automotive
11.
Chemicals
12.
Machinery & Equipment
13.
Pharmaceuticals
14.
Electronics
15.
Media and Communication, Advertising and Promotion
16.
Software/Information Technology
17.
Transportation, Shipping, Transportation Infrastructure
18.
Trading, Distribution, Logistics
19.
Packaging
20.
Hotels
21.
Educational services/Academia
22.
Childcare/Daycare
23.
Household Durables
24.
Medical equipment and services
25.
Retail
26.
Security services and correctional facilities
27.
Restaurants, bars, carryout food
28.
Law Firm
29.
Accountant
30.
Consultant
31.
Business process outsourcing
32.
Woodworking
33.
Cleaning Services
34.
Venues: wedding, party, entertainment (non-restaurant/bar)
35.
Nonprofits
36.
Healthcare
37.
Fitness
38.
Salon/Barber/Spa
39.
Other: Please list below.
40.
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39. Industry: Other: Please describe/list.
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Please select number of employees not including owner in Jackson County
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1-10
11-50
51-200
201-500
501-1000
1001-5000
5001-10,000
10,001+
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Section 2 of 2
CULTURE/LEADERSHIP
1) Is the business LGBTQIA+ Owned (or Managed, in the case of non-profit organizations)?
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Yes
No
Partially
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2)  Do you have a Non-Discrimination Policy or equivalent, in writing?
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Yes
No
No, but we anticipate adopting this in the next year.
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3) Is your Non-discrimination Policy publicly available? 
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Yes
No
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4) If your policy is publicly available, please provide a link/URL:
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5) Does your Non-Discrimination Policy or Equivalent include:
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Sexual Orientation
Gender Identity
HIV+ status
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6) Do you provide all-gender (gender-neutral or single stall/any gender) restrooms for your employees?
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Yes, at all business locations.
Yes, at some business locations.
No
No, but we anticipate adopting this in the next year.
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7) Is LGBTQIA+-inclusivity a part of your employee training?
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Yes
No
No, but we anticipate adopting this in the next year.
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8a) Do your business-provided employee benefits include: 
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a. Domestic partner benefits
b. Transgender-inclusive benefits, such as health care that provides for gender transition
c. Parent leave that includes adoption
d. Other (describe below)
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8b) Please describe "Other" from above, if any.
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9) Do you have any best practices that support the attraction and retention of LGBTQIA+ employees? If so, please list/describe.
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10) Does your business have a publicly-available commitment to the LGBTQIA+  community, such as to serve this community without bias/discrimination?
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Yes
No
No, but we anticipate adopting this in the next year.
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add "Other"
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11) If your commitment statement is publicly available as indicated in #10 above, please provide a link.
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12) Do you provide all-gender/gender-neutral restrooms for your customers?
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Yes, at all business locations.
Yes, at some business locations.
Option 5
No
No, but we anticipate adopting this in the next year.
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13) Outside of general efforts to provide an inclusive environment for the LGBTQIA+ community, do you offer tailored/specialized products and services to meet the specific needs of the LGBTQIA+ community? (Example: Physicians or therapists that have specialized training in LGBTQIA+ care). If so, please explain.
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14) Do you have any other best practices that support the LGBTQIA+ community that you would like to share here?
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15) Would you want to be listed as a LGBTQIA+ inclusive business/organization in our external-facing database?
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Yes
No
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add "Other"
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16) Are you interested in partnership or volunteer opportunities with Jackson Pride?
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Yes
No
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add "Other"
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17) If your business receives recognition as an LGBTQIA+ inclusive organization, will it be publicly displayed? 
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Yes; please provide recognition with a letter and a rainbow "window cling" sticker.
Yes, and I have it already.
No
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18) Please use this space to indicate any feedback you have for Jackson Pride about this process.
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19) Before submitting, does your CEO approve of/sign off to this survey?
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Yes, my CEO has approved of and signs off to this survey.
My CEO has approved of and delegated the survey submission to me.
No, my CEO has not approved of nor seen this survey submission.
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Thank you for your time and consideration! Please push "Send" when completed.
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Untitled Title
David V. Hind
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Title of Person Completing Survey
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Company/Organization Name
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Contact Information: Mailing Address Line 1
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Contact Information: Mailing Address Line 2
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Contact Information: City, State, Zip
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Contact Information: Phone Number
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Contact Information: Email Address
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Please select an industry: 
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39. Industry: Other: Please describe/list.
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Please select number of employees not including owner in Jackson County
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CULTURE/LEADERSHIP
1) Is the business LGBTQIA+ Owned (or Managed, in the case of non-profit organizations)?
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2)  Do you have a Non-Discrimination Policy or equivalent, in writing?
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3) Is your Non-discrimination Policy publicly available? 
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4) If your policy is publicly available, please provide a link/URL:
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5) Does your Non-Discrimination Policy or Equivalent include:
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6) Do you provide all-gender (gender-neutral or single stall/any gender) restrooms for your employees?
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7) Is LGBTQIA+-inclusivity a part of your employee training?
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8a) Do your business-provided employee benefits include: 
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8b) Please describe "Other" from above, if any.
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9) Do you have any best practices that support the attraction and retention of LGBTQIA+ employees? If so, please list/describe.
No responses yet for this question.
10) Does your business have a publicly-available commitment to the LGBTQIA+  community, such as to serve this community without bias/discrimination?
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11) If your commitment statement is publicly available as indicated in #10 above, please provide a link.
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12) Do you provide all-gender/gender-neutral restrooms for your customers?
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13) Outside of general efforts to provide an inclusive environment for the LGBTQIA+ community, do you offer tailored/specialized products and services to meet the specific needs of the LGBTQIA+ community? (Example: Physicians or therapists that have specialized training in LGBTQIA+ care). If so, please explain.
No responses yet for this question.
14) Do you have any other best practices that support the LGBTQIA+ community that you would like to share here?
No responses yet for this question.
15) Would you want to be listed as a LGBTQIA+ inclusive business/organization in our external-facing database?
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No responses yet for this question.
16) Are you interested in partnership or volunteer opportunities with Jackson Pride?
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No responses yet for this question.
17) If your business receives recognition as an LGBTQIA+ inclusive organization, will it be publicly displayed? 
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No responses yet for this question.
18) Please use this space to indicate any feedback you have for Jackson Pride about this process.
No responses yet for this question.
19) Before submitting, does your CEO approve of/sign off to this survey?
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Thank you for your time and consideration! Please push "Send" when completed.
No responses yet for this question.
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