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Voluntary Demographic Survey for Forward (Self-Identification)

At Forward, one of our core values is to create an environment that embraces and encourages diversity, equity, inclusion, and belonging in order to provide equitable medical care for all. We would greatly appreciate your feedback, via survey, to help us understand and support our DEI&B efforts more thoroughly. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained is anonymized and separate from your name and job application. This information will be kept secure and confidential and will be used solely to aid our DEI&B efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
  • I choose to not disclose
• What are your racial, ethnic, and origin identities?

  Select all that apply

  • Hispanic or Latinx
  • Middle Eastern or Northern African
  • Black or African American
  • Asian
  • White / Caucasian
  • Native Hawaiian or Pacific Islander
  • Indigenous Peoples, First Nations, Native American, or Alaskan Native
  • A race, ethnicity, or origin not shown
  • I choose to not disclose
• What gender do you most closely identify with?
  • Agender
  • Genderfluid
  • Gender non-conforming
  • Genderqueer
  • Female
  • Non-binary
  • Male
  • My gender is not listed
  • I choose to not disclose
• Are you a person of transgender experience?
  • Yes
  • No
  • I choose to not disclose
• What sexual orientation do you most closely identify with?
  • Asexual
  • Bisexual
  • Gay
  • Heterosexual
  • Lesbian
  • Pansexual
  • Queer
  • My sexual orientation is not listed
  • I choose to not disclose
• Are you a veteran / have you served in the military?
  • Yes, I am a veteran
  • No, I am not a veteran
  • I choose to not disclose
• Do you live with a disability (as outlined by the ADA)?
  • Yes
  • No
  • I choose to not disclose