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#123forEquity Goals Update Form

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Thank you for taking the #123forEquity pledge! Please complete this form and provide a brief update about your organization's work to achieve each of the pledge goals. You can include actions you have taken, challenges you have faced, results from your efforts and lessons learned that may be helpful for other organizations.

Organization Name, City and State
Primary Contact Information
How to Share Organization Story
As a reminder, your organization's individual data will be kept confidential. However, if you are willing to share your organization's story with the field, please check how you would be interested in presenting it.
* Please enter goal updates below:
You can attach a supporting document, if applicable, at the bottom of the page.
For personal assistance with the pledge, please contact Harriet McGee, executive assistant of the Institute for Diversity in Health Equity at hmcgee_tmp@aha.org or by phone at (312) 422-2630. For general questions, please email us at equityofcare@aha.org or call (312) 422-2630.
 
Attach your status update file:
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
File Description