Program Diversity Feedback Survey
Share your feedback about your experience with our program’s diversity, inclusion, and sense of belonging.
How satisfied are you with the program’s overall commitment to diversity, inclusion, and belonging?
*
1
2
3
4
5
To what extent do you agree with the following statements about the program?
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The program values diverse perspectives.
1
2
3
4
5
I feel included and respected in the program.
6
7
8
9
10
There are opportunities for everyone to participate.
11
12
13
14
15
The program actively promotes a sense of belonging.
16
17
18
19
20
Which aspects of diversity do you feel are most represented in the program? (Select all that apply)
Race/Ethnicity
Gender Identity
Age
Disability Status
Socioeconomic Background
Other
Have you experienced or witnessed any barriers to inclusion in the program?
*
Yes
No
Prefer not to say
If yes, please describe the barriers you have experienced or witnessed.
What suggestions do you have to improve diversity, inclusion, or belonging in the program?
How likely are you to recommend this program to someone from an underrepresented group?
*
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
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