Awkward Dinner Intake Questionnaire
Thank you for your interest in the South Florida People of Color's "Awkward Dinner" event. The experience is designed to provide an intimate setting to express depth of feeling, an opportunity to be heard, and the chance to learn how to recognize racism in our daily lives. The "awkward" part comes as we invite participants to step beyond their comfort zones to share and learn from diverse perspectives on race in America.

In order to craft an optimal experience for our diners, we need to know a little about you. Please complete the questions below to help us understand who you are and your interest in this conversation.
Email *
What is your phone number? *
Full Name *
Name you prefer to be addressed as (what would you like us to put on your name tag?) *
What pronouns do you want people to use when addressing you (ex. she/her/hers)?
While we know that race is a social construct, within the context of our society, what is your racial identity? *
What is your ethnicity, or the culture with which you identify?
What is/are your religious affiliations or beliefs?
What is your nationality? *
In what city/village do you reside? *
What is the highest level of education you have obtained?
Clear selection
What is your profession?
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