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Salutation
Mr.
Ms.
Mrs.
Miss.
Dr.
Rev.
N/A
First Name
*
Last Name
*
Are you a completing this form as a representative of a nonprofit organization, institution of higher education, or for profit business?
Yes
No
Name of Organization or Business (optional)
Your Title
Business Mailing Address
City
State
Zip Code
Phone Number
Upload logo for promotional and marketing materials (optional)
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Contact Information
(Please note that your personal information will not be shared.)
Mailing Address
City
*
State
*
Zip Code
*
Phone Number (Optional)
What is your Affiliation with the Richard Robinson District Community Benefits Agreement "Area of Focus"?
*
Resident - Property Owner (Owner-Occupied) Residing in RR District
Resident - Renting in RR District
Residential Property Owner (Not Owner-Occupied) in RR District
Commercial/Industrial Property Owner in RR District
Business Owner - Business is Located in RR District
Employee - Working in RR District
Nonprofit Organization Representative - RR District
Member of a Faith Community (Church/Temple/Synagogue) in RR District
Skilled Laborer (i.e. construction, electrician, plumber, etc...)
Wichita State University (WSU) - Student
Wichita State University (WSU) - Administration / Staff
Wichita State University (WSU) - Faculty Member
Wichita State University (WSU) - Alumni
No Affiliation with the RR District- CBA "Area of Focus."
Other
1. Arts & Culture
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
2. Civic Engagement
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
3. Communication
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
4. Employment / Jobs / Training
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
5. Education
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
6. Food Accessibility / Concerns / Insecurity
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
7. Financial Literacy
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
8. Health / Mental Health
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
9. Housing
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
10. Quality of Life / Neighborhood Improvements / Physical Neighborhood / Safety
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
11. Reentry Population
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
12. Relational
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
13. Transportation
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
14. Technology
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
15. Wichita State University
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
16. Youth
YES, I am in agreement and AFFIRM my support of this CBA Community Standard!
No, I am not in agreement with this CBA Community Standard.
Other
Do you feel that there are other "Standards" for our community that were not mentioned above that should be included in this list? Please provide them here:
Email
*
example@example.com
Signature- I affirm the above mentioned themes for our community.
*
Affirm
Should be Empty: