What is your race and/or ethnicity? Check all that apply.
How old are you?
Clear selection
What type dwelling do you live in? *
Do you rent or own? *
Please list any ADA (Americans with Disabilities Act) reasonable accommodations you require to participate in this virtual session. Please provide as much advance notice as possible. Requests for sign language interpreters must be made at least five (5) full business days in advance.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Challenging Racism.