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Demographic Assessment for Communities, Boards, Workgroups, and Councils, F-02870 (08/2021)

Step One

This assessment is a tool to help your group better incorporate voices from diverse communities. The assessment can be completed individually or as a group.

If you choose to complete the assessment as a group, consider whether all present may be equally comfortable speaking. In addition, you should send a hard copy of this assessment to all participants prior to convening, so participants have time to think through responses individually.

1. Consider the population you aim to serve. Are they represented?

Space Cell	We have representation on our team.	We have representation in other ways (e.g., focus groups, etc).	We need representation.	We do not serve this population.
Geographic (e.g., statewide, regional, county, local)	Geographic (e.g., statewide, regional, county, local): We have representation on our team.	Geographic (e.g., statewide, regional, county, local): We have representation in other ways (e.g., focus groups, etc).	Geographic (e.g., statewide, regional, county, local): We need representation.	Geographic (e.g., statewide, regional, county, local): We do not serve this population.
Race and Ethnicity (e.g., Asian/Pacific Islander, Black, Caucasian, Hispanic/Latino, Native American)	Race and Ethnicity (e.g., Asian/Pacific Islander, Black, Caucasian, Hispanic/Latino, Native American): We have representation on our team.	Race and Ethnicity (e.g., Asian/Pacific Islander, Black, Caucasian, Hispanic/Latino, Native American): We have representation in other ways (e.g., focus groups, etc).	Race and Ethnicity (e.g., Asian/Pacific Islander, Black, Caucasian, Hispanic/Latino, Native American): We need representation.	Race and Ethnicity (e.g., Asian/Pacific Islander, Black, Caucasian, Hispanic/Latino, Native American): We do not serve this population.
Sexual Orientation (e.g., heterosexual, lesbian, gay, bisexual, questioning)	Sexual Orientation (e.g., heterosexual, lesbian, gay, bisexual, questioning): We have representation on our team.	Sexual Orientation (e.g., heterosexual, lesbian, gay, bisexual, questioning): We have representation in other ways (e.g., focus groups, etc).	Sexual Orientation (e.g., heterosexual, lesbian, gay, bisexual, questioning): We need representation.	Sexual Orientation (e.g., heterosexual, lesbian, gay, bisexual, questioning): We do not serve this population.
Disability (e.g., physical/medical condition, intellectual or developmental disability, emotional/behavioral disorder)	Disability (e.g., physical/medical condition, intellectual or developmental disability, emotional/behavioral disorder): We have representation on our team.	Disability (e.g., physical/medical condition, intellectual or developmental disability, emotional/behavioral disorder): We have representation in other ways (e.g., focus groups, etc).	Disability (e.g., physical/medical condition, intellectual or developmental disability, emotional/behavioral disorder): We need representation.	Disability (e.g., physical/medical condition, intellectual or developmental disability, emotional/behavioral disorder): We do not serve this population.
Socioeconomic Status (e.g., below poverty limit, at poverty limit, above poverty limit, well above poverty limit)	Socioeconomic Status (e.g., below poverty limit, at poverty limit, above poverty limit, well above poverty limit): We have representation on our team.	Socioeconomic Status (e.g., below poverty limit, at poverty limit, above poverty limit, well above poverty limit): We have representation in other ways (e.g., focus groups, etc).	Socioeconomic Status (e.g., below poverty limit, at poverty limit, above poverty limit, well above poverty limit): We need representation.	Socioeconomic Status (e.g., below poverty limit, at poverty limit, above poverty limit, well above poverty limit): We do not serve this population.
Rural/Urban	Rural/Urban: We have representation on our team.	Rural/Urban: We have representation in other ways (e.g., focus groups, etc).	Rural/Urban: We need representation.	Rural/Urban: We do not serve this population.
Religion (e.g., Christianity, Judaism, Islam, Hinduism, Buddhism, no religious affiliation)	Religion (e.g., Christianity, Judaism, Islam, Hinduism, Buddhism, no religious affiliation): We have representation on our team.	Religion (e.g., Christianity, Judaism, Islam, Hinduism, Buddhism, no religious affiliation): We have representation in other ways (e.g., focus groups, etc).	Religion (e.g., Christianity, Judaism, Islam, Hinduism, Buddhism, no religious affiliation): We need representation.	Religion (e.g., Christianity, Judaism, Islam, Hinduism, Buddhism, no religious affiliation): We do not serve this population.
Family Status (e.g., single, married, with or without children)	Family Status (e.g., single, married, with or without children): We have representation on our team.	Family Status (e.g., single, married, with or without children): We have representation in other ways (e.g., focus groups, etc).	Family Status (e.g., single, married, with or without children): We need representation.	Family Status (e.g., single, married, with or without children): We do not serve this population.
Language (e.g., English, Spanish, Hmong)	Language (e.g., English, Spanish, Hmong): We have representation on our team.	Language (e.g., English, Spanish, Hmong): We have representation in other ways (e.g., focus groups, etc).	Language (e.g., English, Spanish, Hmong): We need representation.	Language (e.g., English, Spanish, Hmong): We do not serve this population.
Gender (e.g., male, female, non-binary, transgender, gender queer, gender fluid)	Gender (e.g., male, female, non-binary, transgender, gender queer, gender fluid): We have representation on our team.	Gender (e.g., male, female, non-binary, transgender, gender queer, gender fluid): We have representation in other ways (e.g., focus groups, etc).	Gender (e.g., male, female, non-binary, transgender, gender queer, gender fluid): We need representation.	Gender (e.g., male, female, non-binary, transgender, gender queer, gender fluid): We do not serve this population.
Age (e.g., children, youth, young adults, adults, middle aged, older adults)	Age (e.g., children, youth, young adults, adults, middle aged, older adults): We have representation on our team.	Age (e.g., children, youth, young adults, adults, middle aged, older adults): We have representation in other ways (e.g., focus groups, etc).	Age (e.g., children, youth, young adults, adults, middle aged, older adults): We need representation.	Age (e.g., children, youth, young adults, adults, middle aged, older adults): We do not serve this population.
Education (e.g., no high school diploma, high school diploma, some college, associate’s degree, bachelor’s degree or above)	Education (e.g., no high school diploma, high school diploma, some college, associate’s degree, bachelor’s degree or above): We have representation on our team.	Education (e.g., no high school diploma, high school diploma, some college, associate’s degree, bachelor’s degree or above): We have representation in other ways (e.g., focus groups, etc).	Education (e.g., no high school diploma, high school diploma, some college, associate’s degree, bachelor’s degree or above): We need representation.	Education (e.g., no high school diploma, high school diploma, some college, associate’s degree, bachelor’s degree or above): We do not serve this population.