LSA 7.28 Session Intake Survey
Thank you for taking a few minutes to help me get to know you! As part of my approach, I like to meet people where they are, and your input will help me to do so. Please feel free to reach out to me at if you have any questions. Please know that your answers are confidential and will only be seen by me. I will not reference specific input or names during our workshop but may allude to themes I hear from the collective input. Thank you and I look forward to meeting you!
What is your name & role?
Where are you based?
Why did you choose to attend this workshop?
How do you identify racially?
Clear selection
What do you hope to get out of the workshop & why?
How would you describe the work you have already done around racism and whiteness?
Clear selection
Please share more context about your answer above
What are your current fears (if any) about engaging in anti-racism? (e.g. being on the journey to be more racially aware and to be part of the solutions)
What else do you want me to know before our workshop?
Thank you!
Never submit passwords through Google Forms.
This form was created inside of Illuminate Coaching & Consulting. Report Abuse