This free survey is powered by
0%
Questions marked with a * are required Exit Survey
 
 
* Thank you for your interest in the Multi-Cultural Diversity Group of Rock Hill, SC.  I am the group leader, Jordache Williams, and I look forward to reviewing the information you submit and the possibility of working with you.  Please understand that this is an annual group with limited seating.  To best serve the needs of the community, I ask that you provide truthful answers to the best of your ability.  Below is my personal disclosure for your review.  Again, thank you for your interest in the group!
 
As a helping professional, my focus is to promote the growth and development of individuals and businesses.   I accomplish this through my role as Program Manager for Atlas Concepts, LLC, as well as by capitalizing on professional development and volunteer opportunities.
 
I am proud to have served for eight years in the United States Army as an Intelligence Analyst.  In this role I was able to strengthen my analytical skills and research ability, as well as improve my proficiency in analyzing and interpreting information in multiple viewpoints.  I gained the respect of my supervisors through performing as a competent leader, responsible for coaching, teaching, and mentoring subordinates and peers.
 
With over nineteen weeks of documented leadership training, I continue to utilize my abilities to influence people by providing direction and motivation purposed with accomplishing specific goals and achieving improvement.
 
I am not an expert on race nor ethnic relations; however, I am a bi-racial male born in 1982.  My life experiences include having been judged because of the way I look, the way I talk, and the way I act.  I have personally experienced prejudice, discrimination, and racism.  That is my context.
 
Furthermore, I have taken numerous courses at the Bachelors and Masters level, in counseling, to include studies of counseling groups.  I am an author as well as a business owner, blogger, life coach, and counseling intern.  Above all, I am a person, much like yourself, with an abundance of personal qualities and inefficiencies which I value differently than each person I meet.
 
I do not have a personal agenda in leading this group and hope the group only serves to benefit all of those who are able to attend.  Thank you in advance for your consideration.
 
Please indicate below that you have read my personal disclosure and agree to being considered for membership in the Multi-Cultural Diversity Group of Rock Hill, SC, under my leadership.
 
I agree
 
 
 
* Rationale: In light of rising racial tensions across the U.S. and the civil unrest which has eased its way into our proximity, it is necessary to provide Rock Hill, SC residents an opportunity for self-exploration of multi-cultural awareness through counsel and dialogue within a culturally diverse group.

Objective: Members take responsibility for their own cultural beliefs and actions, forgive themselves for false assumptions, and more accurately understand and respect the norms and values across cultures.

Priorities: The rights and responsibilities of the group members and leader are contingent on group discussions; however, the following are to be considered priorities: (a) consistent attendance, (b) the physical and psychological safety of all members and the leader, (c) freedom to withdraw, (d) freedom to remain silent on a particular occasion, (e) the right to raise and issue or concern, and (f) confidentiality.

Please indicate that you acknowledge the rationale, objective, and priorities.
 
I acknowledge
 
 
 
* 1.) I have reliable transportation and am willing to meet each Thursday night beginning the last Thursday in June through the last Thursday in September, from 6-7:30PM, at a location within Rock Hill, SC.

2.) I am 24 - 50 years old.

3.) I completed high school or an equivalent (e.g. GED).

4.) I am a resident of York County, SC.

Concerning you, are all of these 4 statements true?
 
 
Indicate your risk of engaging in the following:
No Risk Little Risk Some Risk High Risk
* Verbal Confrontation
-
* Physical Altercation
-
 
 
 
* Do you have a criminal history of violence?
 
 
 
* Have you ever participated in group counseling?
 
 
 
* State your need for being included in this group.
   
 
 
 
* Select all that apply.
 
I am uncomfortable around members of a certain race, based solely on race (can include your own race)
 
I am uncomfortable around members of a certain ethnicity, based solely on ethnicity (can include your own ethnicity)
 
I am prejudice
 
I am racist
 
I believe discrimination is justifiable
 
I believe in a higher power (i.e. religious or spiritual)
 
None of these statements apply to me

 
 
 
* I have either perpetrated, been victimized by, or witnessed prejudice, inequality, and/or discrimination.  Select all that apply.
 
Live and in person
 
Through media exposure (e.g. social media, local/national news)
 
In a historical sense (e.g. formal education, family stories)
 
Does not apply

 
 
Contact Information
* First Name : 
* Last Name : 
Phone : 
* Email Address :