Diversity, Equity & Inclusion (DEI) Survey

Please fill out our optional DEI Survey.  We are measuring our progress and trying get a more complete understand of our membership.

Diversity, Equity & Inclusion (DEI) Survey
1. Name
1. Name
2. Which of the following do your consider yourself primarily to be?
3. What is your primary practice setting?
4. Please indicate your career status.
5. Do you consider yourself to have a disability?
6. What is your race/ethnicity?
7. With which gender identity do you most identify?
If Other: Do you consider yourself to be trans-gender?
8. What are your preferred pronouns?
9. What is your sexual orientation?