New Sample Welcome to your New Sample Name Email Race/Ethnicity Gender Age 18-35 Age 36-55 Age 56-70 Age 70+ I have made a conscious decision to make the cultivation of spiritual resources a part of my practice as a change agent working to help bring about an inclusive, loving, and just community. 1 2 3 4 5 I now use the information I learned about institutional and systemic racism to change my own behavior. 1 2 3 4 5 I am on the ground working from a clear vision and strategy in pursuit of a just and inclusive community. 1 2 3 4 5 I have taken advantage of opportunities to learn about advocacy or social engagement for the purpose of bringing about a more inclusive and just community where I live. 1 2 3 4 5 I can identify spiritual practices that I can use as a resource for "inclusive community" work moving forward. 1 2 3 4 5 I have made a personal decision about the need to address the negative impact of segregated communities. Hardly ever Occasionally Sometimes Frequently Almost always I am aware of the demographics of my community and its history of racial tension or exclusion?Deselect Answer Hardly ever Occasionally Sometimes Frequently Almost always None I am committed to envisioning and planning ways that I can work with others towards building a just, equitable, and loving society. 1 2 3 4 5 On every occasion, I endeavor to incorporate spiritual practices into my life and encourage and inspire the next generation of leaders to undertake this work towards a just and inclusive community. 1 2 3 4 5 I have entered a discernment process for discerning how God may call me to the work of ensuring that my community is inclusive and just. 1 2 3 4 5 I have conversations about the impact of racial divisions in my community with one or more person of different race than me.Deselect Answer Hardly ever Occasionally Sometimes Frequently Almost always None I am aware of my role in doing what I can to foster a just and inclusive community Work. 1 2 3 4 5 I have have given thought to or spoken with someone about needing to learn more about systemic racism. 1 2 3 4 5 I have made a conscious decision to become more informed about unjust cultural and social systems. 1 2 3 4 5 I now use the information learned about institutional and systemic racism to engage my church and community. 1 2 3 4 5 I have a personal plan of action for addressing issues pertaining to racial justice and exclusivity which also include practices for spiritual resources and renewal. 1 2 3 4 5 I have made a public declaration about my desire to personally address policies and practices that perpetuate racial division. Hardly ever Occasionally Sometimes Frequently Almost always I am familiar with social engagement strategies for building Inclusive Communities. 1 2 3 4 5 I can identify clear spiritual, theological, or biblical principles that speak to social Inclusion. 1 2 3 4 5 I have determined, with commitment and energy, that I will move full speed ahead to engage in the work of building a just and inclusive community where I live. 1 2 3 4 5 I have participated in opportunities to help me understand my role as a change agent for the “Beloved Community.” 1 2 3 4 5 I make use of prayer, meditation, study, rituals, celebration, spiritual growth, and other groups to support racial justice and inclusive community efforts. 1 2 3 4 5 I have made a conscious decision to make spirituality and social justice an important component of my Religious witness. 1 2 3 4 5 I have expressed concern about culture and social systems that perpetuate racism. 1 2 3 4 5 I have a clear action plan for coordinating and engaging with others in "inclusive community" work. 1 2 3 4 5 I am a part of an on-the-ground group or network which advocates for a just and inclusive Community. 1 2 3 4 5 I am a part of a discussion or study group in seeks to integrate social justice work, social inclusion to spiritual values. 1 2 3 4 5 I take initiative to confront civic leaders about laws, policies, and practices that perpetuate residential segregation Hardly ever Occasionally Sometimes Frequently Almost always I am currently engaged in social justice work with others in working towards a just, equitable, and loving society. 1 2 3 4 5 I have established a personal plan of action for addressing racial justice and social exclusion in my community. 1 2 3 4 5 1 out of 30 Time's up
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