Ascend Employee/Business Resource Group* Information Collection Form

Employee/Business Resource/Affinity Group/Employee Network* Information Collection Form

*Collectively referred to as E/BRG
Tell Us About Yourself and Your E/BRG
Your Name*

First NameLast Name
Organization/Company Name*
Are you a national or regional leader for your E/BRG?*

NationalRegional (Please provide location in the box below)
Please provide information about your regional E/BRG leaders below. If you do not have regional hubs at this time, please enter N/A*
Email*
example@example.com
Secondary Email
example@example.com
Name of Your E/BRG*
Group Progression Stage:*

BeginnerIntermediateAdvanced
How Many Members are in Your Group?*
Name of Your E/BRG President / Chair*

First NameLast Name
Email of E/BRG President / Chair*
example@example.com
Name of Your E/BRG Co-President / Co-Chair*

First NameLast Name
Email of E/BRG Co-President / Chair*
example@example.com
Name of Executive Sponsor of your E/BRG*

First NameLast Name
Email of Executive Sponsor of your E/BRG*
example@example.com
Location of Organization/Company*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Many Years Has Your E/BRG Been Active?*
E/BRG Website:*
N/A if does not apply
Is your Organization/Company Signatory to Ascend's 5-Point Action Agenda?*

YesNoUnsure
Please visit this website to learn about 5-Point Action Agenda: https://www.ascendleadershipfoundation.org/5-point-action-agenda
Are you an Ascend member?*

YesNo
Is your company an Ascend partner?*

YesNoUnsure
If you are an E/BRG leader, join our exclusive Ascend ERG Network

Please invite your E/BRG leaders to Join our exclusive Ascend ERG LinkedIn Network here: https://www.linkedin.com/groups/12010983/ which is for ERG leaders to engage, network and learn from each other.
Let's keep in touch!

You're an important part of the Ascend mission which is why we'd love to for you to opt-in so we can let you know about research, fundraising, initiatives that we're working on and notify you of our upcoming programs and events. You can opt-out at any time.
Would you like to receive updates about Ascend?

Yes, I would like my email address to be added to the Ascend mailing list to receive communicationsNo, do not add me to the mailing list
Should be Empty:

Employee/Business Resource/Affinity Group/Employee Network* Information Collection Form

Tell Us About Yourself and Your E/BRG

If you are an E/BRG leader, join our exclusive Ascend ERG Network

Let's keep in touch!