Name *

First Name

Last Name

Phone

(###)

###

####

What best describes your role?

Select all that apply.

Human Resources professional

Diversity, Equity and Inclusion specialist

Community Organizer

Nonprofit professional

K-12 educator or administrator

Higher Education faculty or administrator

Faith-based leader

None of the above

Do you have a set group who will enroll or will participants opt in?

We have a set group

We will let group members choose to participate

We are not sure yet

Are you interested in a private course for your group? *

Yes

No

Not sure yet

Would you like Mia to meet with your group virtually or in-person? *

Please note there is an additional fee for these trainings.

Yes

No

Not Sure Yet