Name:

[Your Name]

Department:

Employee ID:

Gender

• Male

• Female

• Non-Binary

• Prefer Not To Say

• Other (please specify): _____________

Ethnicity/Race (optional)

• White

• Black/African American

• Asian

• Hispanic/Latinx

• Native American/Indigenous

• Multiracial/Multiethnic

• Other (please specify): _____________

How long have you been a member of our ERG?

• Less than 6 months

• 6 months to 1 year

• 1 to 2 years

• More than 2 years

Have you attended any ERG events in the past year?

• Yes

• No

How would you rate the effectiveness of our ERG leadership team on a scale of 1 to 5 (1 being ineffective, 5 being highly effective)?

• 1

• 2

• 3

• 4

• 5

How inclusive do you feel our organization is towards the ERG and its members?

• Not at all inclusive

• Somewhat inclusive

• Moderately inclusive

• Very inclusive

• Extremely inclusive

Do you feel supported by the organization in your involvement with the ERG?

• Not supported

• Somewhat supported

• Moderately supported

• Very supported

• Extremely supported

How well do you think the ERG communicates with its members?

• Poorly

• Fairly

• Adequately

• Well

• Excellently

Has the ERG helped you achieve any personal or professional goals?

• Yes

• No