NEACSM Diversity, Equity, and Inclusion Survey
The NEACSM Diversity Committee would like to learn more about your experiences with NEACSM and in your field regarding diversity, equity, and inclusion. Please answer the following questions. Your answers will be kept confidential. Your input is very important to us! Questions? Contact us at neacsm1@gmail.com.
Sign in to Google to save your progress. Learn more
How do you feel about the climate in your field regarding diversity, equity, and inclusion?
What do you see as the Chapter’s role in promoting diversity, equity, and inclusion to improve the climate in your field?
What is your age?
Clear selection
What is your racial identity, i.e., with which racial group(s) do you identify? Choose as many as apply.
What is your nationality, i.e., in which country were you born?
What is your ethnicity, i.e., with which ethnic group do you identify?
What is your sexual orientation, i.e., with which sexual orientation do you identify?
Clear selection
What is your gender identity, i.e., with which gender do you identify?
Clear selection
Do you have a disability? If "yes," what is your disability?
Do you identify with any of the following religious groups or belongings? Choose as many as apply.
What is your professional level within NEACSM, i.e., undergraduate student, graduate student, faculty, etc.?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of UMass Boston.

Does this form look suspicious? Report

Google Forms