BIPOC C-Suite Research Participation Forms

recruiting BIPOC Executive healthcare leaders in Texas

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Learn More
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Participate
Study Overview
Questionnaire
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Home
About
Learn More
Schedule
Participate
Study Overview
Questionnaire
Consent

Participant Questionnaire

This questionnaire collects data to outline the demographic characteristics of the study’s target participants and ensures they meet the inclusion criteria for participation. The results are presented in a way that keeps participant information anonymous and nonidentifiable.

1. What is your gender?*

Male

Female

Self-identified

2. What is your age?*

Under 30

31 - 39

40 - 49

50 - 59

60 and over

3. As a BIPOC individual please specify your race and ethnicity. For example: Jamaican, Native American, Alaska Native, African American, Black, Latino American, Asian American, etc.*

4. What is your highest degree held or level of school you have completed?*

High School or GED

Associates

Bachelors

Masters

Professional or Specialty

Doctorate

5. How many total years of health care experience do you have?*

2 - 6

7 - 11

12 - 19

20 and over

6. How many years have you held your current healthcare C-suite position?*

2 - 6

7 - 11

12 - 19

20 and over

7. How many years of total management or leadership experience did you have prior to obtaining your current C-suite position? *

2 - 6

7 - 11

12 - 19

20 and over

8. How many years of C-suite leadership experience do you have?*

2 - 6

7 - 11

12 - 19

20 and over

9. What is your current C-suite leadership position? For example: President, CEO, COO, CFO, CHRO, CTO, etc.*

Comments

Research

Learn about our BIPOC C-Suite study here.

contact info

Connect

817-993-9074

erick.miller@ciu.edu

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