Innovators Network
Member Information
Innovators Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please select the sector(s) that best represent your organization or perspective within the Innovators Network (select all that apply)
Government (non-elected position)
Non-profit
Faith-based
Education
Business
Youth Services
Health & Wellness Advocate
Social Service
Public Health
Elected Official
EJC Resident
Public Safety Agency
Local Funder
Healthcare
Other
Please select the option(s) that represent how you describe yourself (select all that apply)
American Indian or Alaskan Native
Asian
Black
Hispanic or Latino
Middle Eastern or North African
White
Woman
Man
LGBTQ+
Non-binary or gender non-conforming
Age: 20-35
Age: 36-50
Age: 51-65
Age: 65+
Other
Please select the option(s) that represents the communities your agency serves or community you represent (select all that apply)
Rural/Small town (less than 40,000 pop)
Mid-size town in EJC (41,000-150,000)
Jackson County
Kansas City
Independence
Missouri
Kansas
Other
Submit
Should be Empty: