Sign-on Form: EVALUATING THE RACIAL AND ETHNIC IMPACT OF COVID-19 IN MICHIGAN
Please complete this form to acknowledge your support for the following letter. Please indicate below if you and / or your organization agree to have your name listed publicly and provided to the Michigan Coronavirus Task Force on Racial Disparities.

Read the letter here: https://bit.ly/EvaluateCOVIDMI

First Name *
Last Name *
Title, Organization, or Credentials *
Examples: MSW, Managing Partner at XYZ Firm, Co-Chair of Important Group. Note: We reserve the right to edit or condense your response.
Email *
Zip Code *
I agree that I individually support the content of the letter and that I am willing to be listed as endorsing its contents. *
My organization is interested in being added as an organizational signatory.
Clear selection
Optional: Do you have specific tools or resources that you would like to see developed to address equitable evaluation, or skills you're interested in further developing in your own practice? What are they? And would you like to be a collaborator to develop these tools or training?
Note: These comments will not be shared with your signature.
Optional: Is there anything else that you would like to share with the letter drafting committee?
Note: These comments will not be shared with your signature.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms