Workforce Diversity Leadership Community

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Thank you for your interest in the Pacific Southwest Mental Health Technology Transfer Center's Workforce Diversity Leadership Community!

This five-session learning experience is designed for CEOs, COOs, Executive Directors, Human Resource, and other hiring professionals who seek to achieve and sustain diverse workforces. This learning experience will require continuous self-reflection, authentic and uncomfortable conversations, a community immersion experience, and the development of a plan of action.

Applicants working in the Pacific Southwest Region 9, which includes AZ, CA, HI, NV, and the Pacific Jurisdictions will be given priority. In an effort to enhance the learning experience, participation in this cohort will be limited to 21 participants.

The goal of this application process is to assist us in ensuring the cohort is diverse as possible. Please complete the following application by 5:00 PM PT on Friday, April 15, 2022. We will notify you of your final application status by 5:00 PM PT on Monday, April 25, 2022. Please consider applying with a colleague to increase capacity and implementation within your organization (individual applications required). Thank you! Be safe and be well.

Please contact Dr. Tonicia Freeman-Foster, tfoster@changematrix.org, with any questions or concerns.

Email *

Please share your name: *

Phone Number *

Name of your organization: *

Your role/job title: *

What is your primary employment setting (select one)? *

Community-based organization (including faith-based organizations)

Criminal justice/corrections (court, prison, jail, prison/probation, TASC)

Education: Elementary Or Secondary

Education: College/university, tech, vocational, post-secondary

Mental health clinic Or Treatment organization (Community mental health program)

Military/VA

Primary healthcare Or Medical facility

Substance use clinic Or Treatment program

Solo Or Group practice

State psychiatric hospital

Transitional/supported living facility

Other:

Demographic Questions

The goal of the demographic questions is to assist us in our processes of ensuring each cohort is as diverse as possible.

Please share your race and ethnicity. *

Please share your gender and pronouns. *

Please share your zip code: *

What state or territory do you live/work in? PLEASE NOTE: Individuals who reside in the Pacific Southwest Region will receive preference. *

American Samoa

Arizona

California

Federated States of Micronesia

Guam

Hawaii

Marshall Islands

Nevada

Northern Mariana Islands

Palau

Other:

Required

If you work within a tribal nation, please specify the tribal nation below:

Organization Demographics

Briefly describe the demographic composition of your organization staff, using approximate percentages. Briefly describe the demographic composition of your organization's senior leadership team, using approximate percentages. Briefly describe the demographic composition of your Board of Directors (if applicable), using approximate percentages. *

Briefly describe the demographic composition of the individuals, families, and communities that you committed to provide services to, using approximate percentages. *

What are your organization's workforce diversity strengths? Where are you challenged or struggling? Why? *

Leadership Community Questions

Are you able and available to fully commit to attending all five sessions and completing all independent assignments? Sessions are scheduled from 2:00-4:00PM PST, and will occur on May 9th, June 6th, July 11th, August 1st, and September 12th. *

Yes, I fully commit to attending all sessions and completing all independent assignments

No, I cannot commit at this time

This Leadership Community will require self-reflection and active participation in challenging conversations. Are you fully committed to engaging in this experience? *

Yes

What are you hoping to gain or enhance through your participation? *

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