ROOTED Interest & Screening Form

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ROOTED Interest & Screening Form

ROOTED (Raising Our Offspring Together Every Day) is a project being conducted that is looking to talk with parenting teams to see how they navigate teaching their Black youth about race.

* Indicates required question

Your Name (Last, First) *

Your answer

Phone Number(s) *

Your answer

E-mail Address *

Your answer

Gender *

Woman

Man

Non-Binary

Other:

Ethnicity/Race (check all that apply) *

African-American/Black

Caucasian/White

Hispanic/Latinx

Native American\Alaska Native

Hawaiian Native, Pacific Islander

Asian

Other:

Required

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