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Prospective Client Questionnaire
PRIVACY: Your organization's privacy is important to us. Becoming Better Together agrees not to share any information collected within this survey and will only use the information for the purposes of developing a scope of work specific to your organization and its needs.
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* Indicates required question
Email
*
Your email
Organization name:
*
Your answer
Your name:
*
Your answer
Phone Number
*
Your answer
What is the primary change you want to see within your organization and what support are you looking for?
*
Your answer
Why do you / does your organization want to engage in this work right now?
*
Your answer
When would you ideally like to start an engagement?
*
MM
/
DD
/
YYYY
How long do you anticipate the engagement will last?
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< 3 months
3 - 6 months
6 - 12 months
12 - 24 months
> 24 months
Other:
When do you need to complete this engagement?
*
MM
/
DD
/
YYYY
Do you have any flexibility with the start date or timing of completion? If so, please share any information that would be helpful in our planning.
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Your answer
What is your budget for this engagement?
*
<$10,000
$10,000 - $20,000
$21,000 - $30,000
$31,000 - $40,000
$41,000 - $50,000
$50,000 - $75,000
$76,000 - $100,000
$100,000 - $150,000
> $150,000
Other:
How many total employees does your organization have?
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< 10 employees
10 - 25 employees
25 - 50 employees
50 - 100 employees
100 - 250 employees
250 - 500 employees
> 500 employees
How many people from your organization do you anticipate will be involved in this engagement?
*
Your answer
What commitments to diversity, equity and inclusiveness has your organization made?
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named a core value related to diversity, equity or inclusiveness
amended operational processes for equity
articulated a business case specific to diversity
made an explicit commitment to anti-racism
Other:
How have your organization's senior leaders demonstrated their level of commitment to equity?
*
authorizing a committee or working group focused on diversity, equity, and inclusiveness
allocating resources to advancing goals around diversity, equity, and inclusiveness
named diversity, equity, and inclusiveness as an organization priority
engaged in their own learning and development related to diversity, equity, and inclusiveness
Other:
What are the racial and gender demographics of your organization?
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Your answer
What is the racial and gender distribution across roles within your organization (e.g. CEO, managers, coordinators, etc.)?
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Your answer
What can you share with us about employee engagement (satisfaction, retention, promotion, etc.)?
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Your answer
Based on our organization's employee engagement scores, most people find our organization to be:
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Very exclusive
Exclusive
Somewhat inclusive
Inclusive
Very inclusive
Other:
What has your organization done to develop a shared language and understanding of the terminology related to diversity, equity, and inclusiveness? (Check all that apply.)
*
Organization wide reading (i.e. articles or book club)
Trainings
Affinity groups and/or Caucus groups
Self-directed learning
Other:
Required
Our organization has checks and balances to ensure fair processes and equitable access to opportunity as it relates to: (Check all that apply.)
*
Recruitment
Hiring
Promotion
Compensation
Decision making
The terminology of fair processes and equitable access is unfamiliar to our organization
Other:
Required
Our organization actively works to interrupt systems of oppression within:
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Strongly disagree
Disagree
Agree
Strongly agree
The terminology of systemic oppression is unfamiliar to our organization
Our country
Our organization
Our teams
Ourselves and between people
Strongly disagree
Disagree
Agree
Strongly agree
The terminology of systemic oppression is unfamiliar to our organization
Our country
Our organization
Our teams
Ourselves and between people
Our organization explores social identity, intersectionality, and how those impact interactions at work.
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Never
Rarely
Sometimes
Often
Always
The terminology of social identity and/or intersectionality is unfamiliar to our organization
Other:
How did you hear about us?
*
Internet search
Conference
Referral
Other:
Anything else you'd like us to know?
*
Your answer
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