Inclusive Dubuque Organization Partnership

Inclusive Dubuque Organization Partnership
After you have read the Inclusive Dubuque Partnership document, fill out the below form and submit if your organization would like to become an Inclusive Dubuque partner. By filling out and submitting the form, your organization agrees to adhere to the belief statements of the Inclusive Dubuque network.
Organization *
Name *

First Name Last Name
Title *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

- Area Code Phone Number
Website *
Are you representing:

An entire organization A department within an organization
Has your organization:

Developed and implemented a diversity or inclusion plan, equity work plan, or strategic plan? Implemented a social and racial equity and inclusion tool in routine decision making? Required intercultural competency training for administration and staff? Built organizational infrastructure to advance social and racial equity and inclusion? Adopted an executive order that describes your organization’s equity and inclusion commitment?
Inclusive Dubuque is a peer-to-peer sharing and learning network, so all partners must commit to active participation to maintain the overall effectiveness of Inclusive Dubuque. Can you or representatives from your organization commit to any of the following?
Attend regular monthly meetings

Yes No
Actively share successes and failures with other members of the Network

Yes No
Inclusive Dubuque communications: opening 2/3 of weekly updates and newsletters

Yes No
Respond to an annual member survey

Yes No
Actively participate in an Inclusive Dubuque sector group

Yes No
For professional development opportunities, encourage employees to participate in monthly meetings, learning opportunities, and sector group work

Yes No
Are you able to organize other staff in your organization to participate in the activities of Inclusive Dubuque in order to broaden the network’s peer-to-peer engagement and learning opportunities?

Yes No
Please answer any of the following questions that apply to your organization:
Sharing your experiences that have furthered equity and inclusion with other Inclusive Dubuque partners will help network partners deepen their understanding of important ideas and information related to inclusiveness. If possible, describe one or two social or racial equity policies or practices from your organization or life experience that you are willing to share with other network partners. What results have you achieved? What lessons might help other organizations?
Describe one of your top equity and inclusion priorities in more detail. What is your goal? What is your strategy for achieving the goal?
Describe an inclusion and equity challenge you might be facing in your organizations. How might your peers from the Inclusive Dubuque Network be of assistance?
How will you measure the success of your participation in the Inclusive Dubuque Network?

New connections I make Ideas and practices I share outside the network through my participation in the network Ideas and practices I adopt or my organization adopts because of my participation Progress my organization or I make in addressing key diversity or inclusion challenges Practice and use of the tools learned in the network in order to contribute to the field of social and racial equity Other option
Inclusive Dubuque partners have formed focus area sector groups where members meet monthly to discuss and formulate action plans that address implicit and explicit bias within sector areas. Indicate below if you or one of your colleagues might be interested in joining any of the focus area sector groups. More information will be available after the application process.
Network Impact Council

Want to participate Want to learn more One of my colleagues would like to participate
Peer-Learning Council

Want to participate Want to learn more One of my colleagues would like to participate
Data Team

Want to participate Want to learn more One of my colleagues would like to participate
Housing

Want to participate Want to learn more One of my colleagues would like to participate
Transportation

Want to participate Want to learn more One of my colleagues would like to participate
Health

Want to participate Want to learn more One of my colleagues would like to participate
Education

Want to participate Want to learn more One of my colleagues would like to participate
Economic Wellbeing

Want to participate Want to learn more One of my colleagues would like to participate
Thriving/Safe Neighborhoods

Want to participate Want to learn more One of my colleagues would like to participate
Arts and Culture

Want to participate Want to learn more One of my colleagues would like to participate
Other areas of interest:
Inclusive Dubuque Network communications often briefly profile new Inclusive Dubuque partners. Do you have a short biography you can share? We especially appreciate any information on the equity work you are focusing on in your organization. You can paste the text below or provide a link to an online biography. Responses may be revised or abbreviated, but will always be sent to you for approval before distribution.
Do you have best practices or media coverage on your work that you can share with Inclusive Dubuque partners? You can add text or provide a hyperlink. This information may be shared with members through the website and e-news on your behalf.
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