LENS 2023-24 Leader Questionnaire

Directions: This survey is to be completed by the leader who has been registered to participate in the LENS program for the 2023-24 academic year.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Preferred Name (if different than your first name)

4. Name of Your Organization or School *This question is required.

5. If applicable, Name of Your School Campus

6. What community does your school serve? (City, State) *This question is required.

7. Job Title *This question is required.

8. Grade levels you support *This question is required.

9. Mobile Phone Number *This question is required.

10. Work Email Address *This question is required.

11. Personal Email Address

Upon completion of the program, this address will be added to our LENS Alumni database so we can stay in touch even if your work email address changes.

*This question is required.

12. What is your full home address? (Please Include Street Name & Number, City, State & Zip)

13. Self Identification: What is your gender? (Why do we ask this?) *This question is required.

Please enter an 'other' value for this selection.

14. What pronouns do you use? *This question is required.

they/them
she/her
he/him
I do not use pronouns, please use my name
I do not wish to disclose
Prefer to self-describe: Please enter an 'other' value for this selection. * This question is required.

15. Please select all of the following categories with which you identify. (Why do we ask this?) *This question is required.

16. Do you identify as a person of color? (Why do we ask this?) *This question is required.

17. Are you a first-generation college graduate? *This question is required.

18. Are you a veteran of or currently serving in the US Armed Forces? *This question is required.

19. Please select all of the additional languages that you speak fluently.
.

20. Which other professional development and training have you participated in?

21. Please indicate any dietary restrictions.

BES is committed to providing a healthy, safe menu for you during in-person events. BES will work to accommodate any restrictions indicated here and will communicate with you individually if specific menu adjustments are unavailable.

No dietary restrictions
Gluten allergy/intolerance
Lactose intolerance
Nut allergy (peanuts and/or tree nuts)
Pescatarian
Seafood allergy
Vegetarian
Vegan
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

LENS 2023-24 Leader Questionnaire

Section 1: Leader Information