Black Survivors Collective - Orange County Rape Crisis Center

The Orange County Rape Crisis Center (OCRCC) staff is a team of dedicated advocates who wish to enhance their services to all members of the community by taking an intentional approach toward equity, inclusiveness, anti-oppression, and anti-racism. The racial equity consultant, Chimi Boyd-Keyes (more info at http://www.chimi.biz) is facilitating ways to give the Black survivors of sexual violence an opportunity to give feedback on how OCRCC addresses racial equity. The staff welcomes you to share your thoughts and insights! For more information, contact Chimi directly at cbkenterprises@gmail.com

If you wish to be interviewed by Chimi, the racial equity consultant, feel free to complete this form. The interview should last no longer than 30 minutes. You will be asked to give a contact phone number. You can use your actual name or make up a name, as long as you feel comfortable. Your identity will be kept confidential.  Chimi will attempt to reach out to you to schedule an interview time. Thank you!
The name you wish to be called *
Contact number (include area code) *
Dates and times that you are available to be reached to set up an interview *
Is this private phone number? *
Is it okay if Chimi leaves a message? *
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy