Changemakers Submission Form

The Changemakers project is funded by a grant from the Kienle Center for Humanistic Medicine. The goal is to weave the experiences of the workforce around race and ethnicity into short film vignettes that will educate our coworkers in an interactive experience.
  • All stories will be anonymous and de-identified.
  • Answers to questions below are optional. Please provide as much information as you feel comfortable sharing.
  • Stories will be compiled and made into vignettes that will capture the experience while avoiding specifics that might make individuals identifiable.
  • This form is not intended for reporting incidents. If interested in reporting an incident, please contact your Human Resources representative.