CBCA Board of Directors Application – Demographic Survey

The purpose for collecting this voluntary demographic information is to ensure CBCA is authentically working towards a more equitable and inclusive culture at all levels of the organization. Individual responses will only be viewed by select staff and Board Recruiting Committee members and will not be shared or reported publicly. Only aggregate data will be shared and reported to a broader internal audience and/or publicly.

Name
Gender
Please check all that apply
Pronouns
Please check all that apply
Do you identify as a member of the LGBTQ+ community?
Race
Please check all that apply
Ethnicity
Please check all that apply
Age
Please check all that apply
Month/Date only
Do you identify as a person who has a disability?
Geographic: Primary Residence
Please add specifics of where in the region (e.g., Ft. Collins, Grand Junction):
Geographic: Work Location
Please add specifics of where in the region (e.g., Ft. Collins, Grand Junction):