Racial Equity Course Pilot Registration

Racial Equity Course Registration Form

Racial Equity Judicial Education Program with Flaschner Judicial Institute

Wednesday, February 12, 2025, 12:00pm - 4:30pm

Venue: Lexington, Massachusetts

First Name

Last Name

Email

Direct Line Phone Number

What is your current job/professional title?

What agency/court/organization do you currently work for?

What state do you primarily work in?

If you answered "Other" above, please specify here.

Years in current position?

0-5

6-10

11-15

16+

If you answered "Other" above, please specify here.

Have you attended other trainings on law topics related to the social determinants of health (mental health, violence & abuse, poverty, aging, neighborhood safety, education, health behaviors, housing, job & income, access to clinical care, access to childcare, or infrastructure & transportation)? If so, please name the organization that hosted the training & the content covered.

If you answered "Other" above, please specify here.

What is your gender identity?

If you answered "Other" above, please specify here.

How would you describe your racial identity? (Check all that apply)

How would you describe your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Please let us know in the space provided if you have any accessibility needs or request any accommodations to facilitate your full participation in the training (e.g. captioning, large print, wheelchair access)

Thank you for submitting! A member of the Salus Populi team will be in touch with you shortly.