Demographic Information

Module 1: Fundamentals of Leadership Demographic Information

We would like to know a little more about you so we can better understand how the Leadership Academy is serving a diverse workforce. Please enter your information in the fields below. Your personally identifying information, such as name and email address, will never be associated with any of the feedback you share for the Leadership Academy evaluation.

LA Demographic Form

Name

First

Last

Work Email

Agency

Job Role/Title

Region/Area

What is your gender?

If you prefer to self-describe please answer here

Do you identify as transgender?

Yes

What is your age?

What is your highest educational degree?

Other (please specify)

Do you have a social work degree?

If your degree is not in social work, please specify your field of study

Which best describes your race/ethnicity?

Other (please specify)

Do you identify as a person of color?

Yes

Approximately how many years have you worked in your current position?

Approximately how many years have you worked at your agency?

Approximately how many years have you worked in child welfare

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Module 1: Fundamentals of Leadership<br><br>

Demographic Information