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UC Health Application

Application for UC Health’s Diversity, Culture & Inclusion Council

What is your name?*
What is your Title/Role?*
What is your Race/Ethnicity?*
- Native American
- Asian/East Indian
- Black/African American
- Hispanic/Latino
- Multi-Racial
- Nativa Hawaiian/Pacific Islander
- White
What is your Gender?*
- Male
- Female
- Other
How long have you worked at UC Health?*
- Less than 6 months
- 6-12 Months
- 1-3 Years
- 3-6 Years
- 6-10 Years
- 10-15 Years
- 15-20 Years
- 20-30 Years
- 30 or More Years
What is your Council Location?*
- UC Medical Center (UCMC)
- West Chester Hospital
- Daniel Drake Center for Post-Acute Care
- UC Health Business Center
- UC Health Ambulatory - North
- UC Health Ambulatory - South
What is your email address?*
Please provide the best number to reach you?*
What is your manager's name?*
In what ways do you believe that the Council can add value to the organization?*
Why are you interested in serving on the Diversity, Culture & Inclusion Council?*
What do you perceive will be the most significant challenges that the Council members will face?*
What knowledge, skills and experience do you believe you would bring to the Council?*

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