CEDO 2016 2017 Applicant information Organization Name Main Contact Person/Title Address Phone Website Email Organization Data If returning, what year did your organization join the program? 2010 ____ 2011 ____ 2012 ____ 2013 ____ 2014____ 2015____ Organization Budget ____<$1,000,000 _____$1,000,000 to $2,000,000 ___>$2,000,000 Program Training Fee ____$3,200 _____$5,000 ___$6,000 Demographic Survey Please complete table with numbers , not percentages Leave – – blank if no data collected median Income approx or Moderate (over American of family) White Male/Female/Other Multi-Race Native African African-American Asian (80% Above TOTAL Latino Low/Mod $50K/ $50K/family) income, Income Population Served Agency Staff Board of Directors 1. Summary 250 words – Describe your agency and your effort to be more culturally competent, share one change you have made. (Brief definition: Cultural competence is a developmental process of both individuals and organizations to raise awareness, knowledge and skills to work across difference.)
CEDO 2016 2017 Applicant information Organization Name Main Contact Person/Title Address Phone Website Email Organization Data If returning, what year did your organization join the program? 2010 ____ 2011 ____ 2012 ____ 2013 ____ 2014____ 2015____ Organization Budget Program Training Fee ____<$1,000,000 _____$1,000,000 to $2,000,000 ___>$2,000,000 ____$3,200 _____$5,000 ___$6,000 Demographic Survey – Please complete table with numbers , not percentages – Leave blank if no data collected Male/Female/Other African or African-American Asian Latino Native American White Multi-Race Low/Mod Income (80% of median income, approx $50K/ family) Above Moderate Income (over $50K/family) TOTAL Population Served Agency Staff Board of Directors 1. Summary – 250 words Describe your agency and your effort to be more culturally competent, share one change you have made. (Brief definition: Cultural competence is a developmental process of both individuals and organizations to raise awareness, knowledge and skills to work across difference.)
CEDO%20Equity%20and%20Inclusion%20Training%20Application%202016%202017.docx