Chicago Digital Equity Coalition Interest Form

Hello Prospective Digital Equity Coalition Member,

We are excited to be launching a Digital Equity Coalition in Chicago! The purpose of this Coalition will be to set goals, align resources, advocate, and network effectively to advance digital equity in Chicago.

This Coalition is geared toward non-profits, community-based organizations, faith-based organizations, and government entities working toward closing the digital divide. We also welcome community members who are interested in this topic. Please note we will be launching a working group comprised of private sector and for-profit representatives who are committed to supporting the work of this Coalition in a separate forum. Thank you for your interest!

- City of Chicago and Digital Equity Coalition Launch Team

Should you have any questions, please email
digitalequity@cityofchicago.org

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First Name *

Last Name *

Email *

Title *

Organization Name *

What type of organization are you affiliated with?*

Non-Profit or Community Based Organization

Faith Based Institution

Government Entity

None, I am a community member interested in this topic

Private Sector or For Profit

Other

If you selected “Other”, please share your organization type:

Preferred email for Coalition communications? *

Preferred phone number for Coalition communications? *

What community or area of the city does your organization serve? *

(Optional):Which race(s) or ethnicity(s) best describe you.Please check all that apply. (The purpose of asking is to ensure we are achieving our goal of convening a diverse and representative Coalition)

Black or African American

Hispanic

Asian / Pacific Islander

White / Caucasian

American Indian or Alaskan Native

I prefer not to share

Other

In 1-2 sentences, please share why you are interested
in joining the Digital Equity Coalition. *

What are generally good times for you to attend meetings on week days? Please check ALL times that apply. Note: We will do our very best to accommodate times that work for most.

Early Mornings (8 - 10am)

Mid day (10 am - 2pm)

Late Afternoons (2-5 pm)

Evenings (5 - 8 pm)

(Optional): Please describe any additional schedule restrictions or things we should know about as it pertains to when you can meet.

Our meetings will be hosted in English and Spanish. Would you prefer to engage in meetings through a Spanish-speaking interpreter?*

Yes, I would like a Spanish-speaking Interpreter

No, I will not need a Spanish-speaking Interpreter

Maybe

Do you have any food allergies/dietary restrictions? If so, please list here or type N/A.*

(Optional): What else do you need to ensure you are able to engage in meetings (virtually or in-person)? Please use this space to further elaborate on any of your responses above or other accommodations you may need.