Inclusive Dubuque Individual Partnership

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 NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Have you ever:

Been trained as a facilitatorDeveloped and/or implemented a diversity or inclusion plan, equity work plan, or strategic planImplemented a social and racial equity and inclusion tool in routine decision makingParticipated in intercultural competency training or workshopsParticipated 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

YesNo
Actively share successes and failures with other members of the Network

YesNo
Inclusive Dubuque communications: opening 2/3 of weekly updates and newsletters

YesNo
Respond to an annual member survey

YesNo
Actively participate in an Inclusive Dubuque sector group

YesNo
Participate in monthly meetings and learning opportunities (such as intercultural competency training or poverty simulations)

YesNo
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?

YesNo
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 makeIdeas and practices I share through my participationIdeas and practices I adopt because of my participationProgress I make in addressing key personal and work diversity and inclusion challengesPractice using the tools learned through the Network that contribute to creating a community where all people feel respected, valued, engaged, and treated fairlyOther
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 participateWant to learn more
Peer-Learning Council

Want to participateWant to learn more
Data Team

Want to participateWant to learn more
Housing

Want to participateWant to learn more
Transportation

Want to participateWant to learn more
Health

Want to participateWant to learn more
Education

Want to participateWant to learn more
Economic Wellbeing

Want to participateWant to learn more
Thriving/Safe Neighborhoods

Want to participateWant to learn more
Arts and Culture

Want to participateWant 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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