#123forEquity Goals Update Form

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Thank you for taking the #123forEquity pledge! Please complete this form and provide a brief update about your organization's work to achieve each of the pledge goals. You can include actions you have taken, challenges you have faced, results from your efforts and lessons learned that may be helpful for other organizations.

* Organization Type:
* State:


* CEO Name:
* Primary Contact:
* Primary Contact E-Mail:
* Primary Contact Phone:

As a reminder, your organization's individual data will be kept confidential. However, if you are willing to share your organization's story with the field, please check how you would be interested in presenting it.
Case Example
Social Media

* Please enter goal updates below:
You can attach a supporting document, if applicable, at the bottom of the page.

Goal 1: Increase the collection and use of race, ethnicity, language preference and other patient characteristic data, such as socio-economic status, LGBTQ, veteran status, disabilities, etc.

Goal 2: Increase cultural competency training.

Goal 3: Increase diversity in leadership and governance.

Goal 4: Please provide an update on efforts within your organization or in the community related to health equity and diversity and inclusion, which may not fit clearly under one of the pledge goals listed above.

For assistance, please contact Sharon Allen, senior executive director of the Institute for Diversity in Health Management, at sallen@aha.org or by phone at 312-422-3722.

Attach your status update file:
Allowed file types: pdf, docx