Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Thank you for your interest in Perception! Thank you for your interest in Perception Strategies! In an effort to ensure that Perception’s mission and approach aligns with your organization, we are enhancing our intake process. Please complete the form below. OK Question Title * 1. Name OK Question Title * 2. Title OK Question Title * 3. Organization OK Question Title * 4. What is your organization's physical address? OK Question Title * 5. Email Address OK Question Title * 6. Phone Number OK Question Title * 7. What brings you to Perception? To develop/improve an equity-related initiative or strategic plan To provide equity-related education to leadership and/or staff To support leadership in fulfilling stated commitments to advancing equity and belonging To respond to staff demands To respond to an internal incident (e.g., incident within your organization) To respond to an external incident Other (please specify) OK Question Title * 8. What is your primary interest in reaching out to Perception? I am primarily interested in services focused on workplace culture, organizational transformation, or leadership development. I am primarily interested in services focused on transforming how my organization or institution serves others (e.g. patients, students, homebuyers / renters, clients, customers, communities, the public). I am not sure. OK Question Title * 9. Is there support for this work within the institution? Yes No OK Question Title * 10. What level of support does the leadership of the organization have for this work? Strongly supports Somewhat supports Does not support Has not expressed an opinion I don’t know OK Question Title * 11. Is equity and belonging stated as a strategic imperative within the organization? Yes No OK Question Title * 12. Which of the following identity dynamics are you most concerned about? [select all that apply] Race Ethnicity Age Class/Socioeconomic Status Gender (identity and/or expression) Disability Religion Sexual Orientation OK Question Title * 13. Which of Perception's services or solutions are you interested in? Learn more about our Services & Solutions here. Advising/Coaching Board Members Committees/Working Groups Executive Team Members Narratives & Content Creation Mediation/Facilitation Services Communications Strategy Community Building Mind Science Workshops Needs Assessment Advising/Coaching: Other (please specify) OK Question Title * 14. Perception leads workshops with a broad variety of participants. Who do you plan to engage in the work? All Staff Board of Directors/Executive Board Managers/Supervisors A subgroup of staff Other (please specify) OK Question Title * 15. What about Perception’s approach resonates with you? OK Question Title * 16. Does your organization have an individual, department, or committee focused on issues of workplace climate and identity (e.g. a Diversity, Equity, and Inclusion Officer or Committee)? Yes No OK Question Title * 17. If you answered 'yes' to question 15, has the person or people already engaged in this work been made aware of your interest in working with Perception? Yes No N/A OK Question Title * 18. If your organization does not have someone or a committee, or they will not be involved in your collaboration with Perception, who will lead this work on behalf of your organization? OK Question Title * 19. What prior work, if any, have you engaged in around issues of race, identity, diversity, belonging, inclusion, and/or equity? OK Question Title * 20. How large is your organization? Less than 50 employees 51-100 employees 101-200 employees 201-300 employees 301-400 employees 401-500 employees 501-600 employees 601-700 employees 701-800 employees 801-900 employees 901-1000 employees More than 1000 employees OK Question Title * 21. Do you have a budget for this work? Yes No Other (please specify) OK Question Title * 22. What is your budget for this work? Perception is mission driven; we use fees in part toward our research and dissemination efforts. $2,500 - $10,000 $10,001 - $50,000 $50,001 - $100,000 $150,001 - $200,000 $200,001+ N/A OK Question Title * 23. What is your timeline for this work? When would you like it to happen? Q1 2023 Q2 2023 Q3 2023 Q4 2023 OK Question Title * 24. What is your ideal outcome for this work with Perception? OK Question Title * 25. How did you learn about Perception? Through a presentation, workshop or CLE Through an existing Perception client Through a former Perception client Through broadcast or print media Through social media Through a search engine Other (please specify) OK Question Title * 26. Please indicate which platform (Twitter, Instagram, Facebook) OK Question Title * 27. Please indicate which search engine (Google, Yahoo, Bing) OK DONE