How can we help you know you belong?
The Midwest Alliance for Mindfulness (MAM) values diversity, equity and inclusion - we welcome all people. This survey is intended to help us build a community in which you can experience true belonging. Your responses are anonymous unless you choose to share your identifying information with us. Thank you!
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MM
/
DD
/
YYYY
How important is a sense of belonging to you when participating in a community? *
Not at All
Extremely
What qualities or factors have helped you feel like you belong in a community? *
What are some barriers that have prevented you from feeling truly welcomed in a community? *
Have you visited MAM yet? *
If you've visited MAM, what are we already doing well, if anything, that helps you feel like you belong in our community?
If you've visited MAM, what more could we do to help you feel like you belong in our community?
If you've visited MAM, is there anything we're doing that is a barrier to your sense of belonging in our community? If so, please describe.
What is your gender identity?
What is your cultural, ethic, and/or racial identity?
Are you a person with a disability?
清除選取的項目
What is your sexual orientation?
What are some of the biggest challenges you face in your life right now? For each category, check the box that fits your experience. Feel free to add your own as well:
0 Not a Problem
1
2
3
4
5
6
7
8
9
10 Extremely Stressful
Financial
Employment
Housing
Parenting or Guardianship
General Stress
Relationships
Mental Health
Physical Health
Discrimination or Social Bias
Transportation
Child Care
Legal
Threat of Violence or Other Crimes
Cultural Identity Stress
Body Dissatisfaction
Feeling Isolated or Alone
Lack of Available Help
Caregiving for Adults
Other 1
Other 2
Other 3
清除選取的項目
Please describe the stressors labeled Other 1, 2 &/or 3 if you ranked them above.
If you’d like one of our teachers to contact you for further conversation about how we can make MAM a more welcoming place, please leave us your name, and email address and/or phone number here:
Thank you for your participation!
As a token of our appreciation for completing this survey, here is a free guided meditation audio recording by MAM teacher Pam Hausner to download for your enjoyment: https://bit.ly/3bTjrEY

If you are hearing impaired and need a transcript of this recording, please contact us here: https://mindfulness-alliance.org/contact/

We welcome you to click or copy and paste the link below into your browser if you'd like to be added to our monthly newsletter about mindfulness: https://bit.ly/2SbuJwj
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