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SHARE YOUR MIXED ROOTS STORY

IDENTITY - Who are you?
FIRST Name*
MIDDLE Name or Initial
LAST Name or Initial*
Email*
Phone
Where / How did you get your NAME and what does it mean?*
Where were you BORN?*
Where did you GROW UP?*
What are some of your BEST memories growing up?*
What are some of your most CHALLENGING memories growing up?*
If you could CHANGE one thing about yourself what would that be?*
What are you the most PASSIONATE about?*
DIVERSITY - What are you?
Please describe your GENDER*
What is your RACE/ETHNICITY/CULTURAL Background*
Describe your FAITH/RELIGIOUS/SPIRITUAL Background*
Describe your FAMILY Background (Spouse, partner, brothers, sisters, children, blended, adoptive, foster, step)*
What is your PROFESSIONAL / EDUCATIONAL Background*
Did you / Do you have a MENTOR play a role in your life and How do / did they MAKE A DIFFERENCE?*
What part / aspect of your DIVERSITY has played the biggest role in your life?*
How / Has RACISM / DISCRIMINATION / PREJUDICE make an impact in your life?*
What is the most UNIQUE thing about you?*
Describe yourself in THREE words*
UNITY - Where are you?
Where do you LIVE right now?*
Where are you on your LIFE JOURNEY now?*
What are you doing to GIVE BACK to the COMMUNITY – How are you MAKING A DIFFERENCE?*
What kind of LEGACY do you want to leave for the NEXT GENERATION?*
What advice would you give to your FUTURE self and NEXT GENERATION?*
If you could CHANGE one thing about the WORLD what would that be?*
What makes you feel that you BELONG?*
What does MIXED ROOTS mean to you?*
UPLOAD Photos (Max 5)
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Accepted file types: jpg, gif, png, Max. file size: 10 MB, Max. files: 5.
UPLOAD Single Featured Gallery Feed Image*
Accepted file types: jpg, gif, png, Max. file size: 10 MB.
By submitting your Mixed Roots Story, you agree you are 18 years or older and/or provide authorization as a legal parent / guardian for any child submitting their Mixed Roots Story and You give us permission to publish and share your Mixed Roots Story and any related uploaded images on this site. You also agree that you may be contacted by us to further give permission to possibly publish your Mixed Roots Story in other multimedia formats such as email newsletter, social media, video and other forms of press and media campaigns outside this site.

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