Racism Is a Public Health Crisis SNCO

DECLARATION OF SUPPORT

RACISM IS A PUBLIC HEALTH CRISIS

The US Centers for Disease Control and Prevention (CDC) has declared that racism is a threat to our public health. Centuries of racism in the U.S. have caused unfair policies in housing, income, healthcare, education, public safety, transportation, and food access that prevent people of color from being healthy - Topeka/Shawnee County included. It will take all of us together to eliminate the barriers that have led to poor health outcomes for communities of color.

We ask you to join us in taking action.

Individuals and organizations are urged to add your name to this declaration, calling on our Shawnee County elected officials to declare Racism Is a Public Health Crisis, and take steps to dismantle systemic practices and policies that perpetuate racism.

Signatures may be listed publicly as community stakeholders that share the commitment to advocating for racial justice as a core element of Topeka & Shawnee County policies, programs, and procedures.

READ THE FULL DECLARATION
SIGN THE FORM
Are you supporting this proclamation as an individual or as part of an organization?*

IndividualOrganization
Name

First NameLast Name
Are you authorized to make this decision on behalf of your organization? If not, please click on the individual option to complete the survey and/or forward the survey to the authorized person within your agency.*

Yes, I am authorized.
Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please include area code.
Email
example@example.com
Website
If you are signing as an organization, please upload your logo.

Uploading a file implies organizational consent for your logo to be used for marketing purposes related to this effort.
Cancelof
Optional Demographic Information
Will you answer 3 questions to help us better understand our audience? These answers will remain confidential.

YesNo
What is your age?

18-24 years old25-34 years old35-44 years old45-54 years old55-64 years old65+ years old
What is your gender?

FemaleMaleTransgenderNonbinaryPrefer not to answerOther
Which race or ethnicity best describes you?

American Indian or Alaska NativeAsian/Pacific IslanderBlack of African AmericanHispanicWhite/CaucasianMultiple/OtherPrefer not to answer
Thank you! Please click the "Submit" button below.
Should be Empty:

DECLARATION OF SUPPORT

RACISM IS A PUBLIC HEALTH CRISIS

READ THE FULL DECLARATION

SIGN THE FORM

Optional Demographic Information

Thank you! Please click the "Submit" button below.