Humanity @ Work by Viva Asmelash
Initial interest form for the program outlined here:
https://www.vivaasmelash.com/dei-project-launchers
* Required
Email address
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Personal Pronouns
*
She/her
He/him
They/their
Other:
Job Title
*
Your answer
Org/Company Name
*
Your answer
Org/Company Type
*
Black-owned business (any industry)
School, school district or non-profit
Tech, finance, fashion, or entertainment (not Black-owned)
Other:
Org/Company Size
*
1-150
151-300
301-500
501-750
751+
How invested do you think your leadership team is in your company's DEI efforts?
*
Very invested
Somewhat invested
Not sure
Interested, but not invested
Not interested or invested
If your company is a Black-owned business, please specify the industry.
Your answer
Are you able to commit to weekly sessions on Thursdays from 3-4:30 PST?
*
Yes
No
Not sure yet
Are you able to commit to 3-4 program hours per week for 4-5 weeks (sessions + homework)?
*
Yes
No, but hope someone else on my team can
Not sure yet
Based on your company's accounting guidelines, are you able to pay for registration via PayPal, or do you another option?
*
Yes
Other:
How did you hear about this program?
*
Your answer
Is there anything else you'd like me to know about you, your team, or your company at this time?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Viva Asmelash Consulting.
Report Abuse
Forms