Online Preliminary Registration Form

Title *

Role as it relates to Diversity, Equity, and Inclusion (DEI): *

How do you prefer to be contacted *

By Email By Phone

About your company

Number of Employees *

Business Operations *

Please paste your organization’s mission statement here. *

Demographics / Representation
Please select all that apply to your workplace. This may be an estimate. We will request specific numbers as stratified across gender and all business levels i.e., from Board of Directors to Entry-Level, after your Introductory Consultation:

American Indian / Native Alaskan *

Asian *

Black / African American *

Native Hawaiian / Pacific Islander *

White / Caucasian *

Hispanic *

The starting line-up

The following five questions are the first that provide Imperative Solutions with a snapshot of your current practice, opportunities, potential threats to success, as well as how we might assist. We will discuss these in further detail during your initial consultation and throughout the client intake process.

1. Does your company capture Diversity, Equity, and Inclusion metrics? *

YES NO

2. Do you currently have a Diversity, Equity, and Inclusion office/officer? *

YES NO

3. How is diversity, equity, and inclusion represented and supported at your company? Please select all that apply *

4a. What are your Diversity, Equity, and Inclusion goals for your organization? *

4b. What has been keeping you from accomplishing them? *

5. When would you like to start? *

Yesterday : Immediately. We are ready to go! 30 - 90 Days : We have approval to retain 3rd party services but are narrowing options. 90 - 120 Days : We are beginning to research programs and providers. 120 + Days : We realize a problem exists but are unsure how/where to start.

How Imperative solutions can help

After reviewing Our Services, which of the following programs – Vanguard, Advocate, or Socratic, is most applicable to your needs?

Choose Your Level of Service *

Vanguard Advocate Socratic

**Executive coaching is a premium service exclusive of any package. Details may be discussed during introductory consultations.**

Please list any other services you would like to add á la carte *

Please feel free to share any additional information or questions you may have. *

By checking this box, I sign that all information on this form is correct to my knowledge *

Yes, this information is correct