Facing Race: My Unfiltered Experience
This survey will be used to guide our conversation for Facing Race: My Unfiltered Experience, held on Wednesday, February 24th from 3:30-5pm via Zoom

If you would like to view this event please visit: https://www.facebook.com/CISofMichigan 

Please complete each question to the best of your ability and write "N/A" if you have no answer or the question does not apply to you. Thank you!
First Name *
Last Name *
Grade *
What District/Region is your school in? *
What school do you attend? *
How strongly do you agree or disagree with the following statement: Events from the past year have affected me (Protests, election, etc.). With 1 representing Strongly Disagree and 5 representing Strongly Agree. *
Strongly Disagree
Strongly Agree
What events have personally affected you and/or your loved ones (friends, family, teachers, etc.)? Write "N/A" if you have no answer or the question does not apply to you. *
How strongly do you agree or disagree with the following statement: I have experienced racism and/or microaggressions at school. With 1 representing Strongly Disagree and 5 representing Strongly Agree *
Strongly Disagree
Strongly Agree
What have been some of your experiences? Write "N/A" if you have no answer or the question does not apply to you. *
What have been some of the conversations you've had with others regarding racism? and with whom? Write "N/A" if you have no answer or the question does not apply to you. *
Are you comfortable having your answers shared anonymously (removing any identifying information) with others? *
Would you like to participate in an honest conversation about your experiences on February 24th? *
Comments, Concerns, and Questions?
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