Name *

Please include middle initial with first name.

First Name

Last Name

Preferred Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone Number

(###)

###

####

Assistant's Name

First Name

Last Name

Organization Type *

Public company

Private company

Nonprofit

Academic institution

Other

Sector *

Accommodation and Food Services

Administration, Business Support and Waste Management Services

Agriculture, Forestry, Fishing and Hunting

Arts, Entertainment and Recreation

Construction

Educational Services

Finance and Insurance

Healthcare and Social Assistance

Information

Manufacturing

Other Services (except Public Administration)

Professional, Scientific and Technical Services

Real Estate and Rental and Leasing

Retail Trade

Transportation and Warehousing

Utilities

Wholesale Trade

How long have you served in your current role? *

Less than one year

One to two years

Two to three years

Three to five years

Five to 10 years

10 or more years

What is your specific role related to DEI within your company? *

I solely lead the DEI efforts (i.e., team of one) and it is 100 percent of my work.

I solely lead the DEI efforts (i.e., team of one) and it is a partial focus of my work.

I serve on a team that focuses 100 percent on DEI.

I serve on a team that partially focuses on DEI.

I lead a team that focuses 100 percent on DEI.

I lead a team that focuses partially on DEI.

Other

How long has DEI been a focus for your company? *

Less than one year

One to two years

Two to three years

Three to five years

Five to 10 years

10 or more years

What percentage of your role is focused on DEI? *

Less than 10%

10-25%

25-40%

40-55%

55-70%

70-85%

85-100%

Grade your organization’s progress on your DEI journey. *

Crawling: preliminary stages of identifying priorities, staff and resources

Walking: staffed and resourced; priorities, staff and resources identified; accomplished a few goals

Running: fully staffed and resourced; accomplished several goals; highly engaged leadership and staff

Does your company have clear, measurable DEI-related goals? *

Yes

Yes, but our company does not have the data or capacity to track progress

No

How optimistic are you that you can accomplish your company's overall DEI-related goals by 2030? *

Very optimistic

Optimistic

Somewhat optimistic

Not optimistic

Specific goals have not been identified

Do you have a dedicated DEI budget? *

Yes

No

If you answered "yes" to the question above, are you confident your budget is large enough to accomplish your company’s overall DEI-related goals by 2030?

Very confident

Confident

Somewhat confident

Not confident

Specific goals have not been identified

Do you feel you have a clear platform or pathway for implementing DEI initiatives at your company? *

Yes

No

How often would you like to convene with fellow DEI leaders? *

Every other month

Quarterly

Semi-annually