Inclusive Dubuque Individual Partnership
After you have read the Inclusive Dubuque Partnership document, fill out the below form and submit if you would like to become an Inclusive Dubuque partner. By filling out and submitting the form, you agree to adhere to the belief statements of the Inclusive Dubuque network.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
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Phone Number
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Area Code
Phone Number
Have you ever:
Been trained as a facilitator
Developed and/or 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
Participated in intercultural competency training or workshops
Participated in any other workshops or trainings focused on implicit or explicit bias
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
Participate in monthly meetings and learning opportunities (such as intercultural competency training or poverty simulations)
Yes
No
Are there family or friends you can invite to participate in the activities of the Inclusive Dubuque Network in order to broaden the network’s peer-to-peer engagement and learning opportunities?
Yes
No
Please answer the following questions in detail, so that we can help you quickly connect with other network partners that may have valuable lessons for you or that may benefit from your experiences. This is a great way to build relationships with others working on similar issues.
Sharing your experiences around equity and inclusion with other Inclusive Dubuque partners will help the network deepen their understanding of important ideas and information related to creating an informed community where all people are respected, valued, engaged, and treated fairly. Describe one or two work or life experience that you are willing to share with other network partners in the next six months. What lessons have you learned that might help other network partners?
Describe an inclusion and equity challenge you are facing in your personal or work life. How might your peers from the Inclusive Dubuque Network be of assistance?
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 through my participation
Ideas and practices I adopt because of my participation
Progress I make in addressing key personal and work diversity and inclusion challenges
Practice using the tools learned through the Network that contribute to creating a community where all people feel respected, valued, engaged, and treated fairly
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 are 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
Peer-Learning Council
Want to participate
Want to learn more
Data Team
Want to participate
Want to learn more
Housing
Want to participate
Want to learn more
Transportation
Want to participate
Want to learn more
Health
Want to participate
Want to learn more
Education
Want to participate
Want to learn more
Economic Wellbeing
Want to participate
Want to learn more
Thriving/Safe Neighborhoods
Want to participate
Want to learn more
Arts and Culture
Want to participate
Want to learn more
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 below. This information may be shared with members through the website and e-news on your behalf.
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