Background

The Advisory Committee for Creating Equitable and Safe Spaces (ACCESS) will participate with projects, conversation and education that create change for people with disabilities throughout Kaleida Health. ACCESS is currently seeking individuals who identify as a person with a disability or are the parent/legal guardian of a loved one with a disability that have physically presented at a Kaleida Health Facility in the last year.

Mission

To evaluate and enhance the physical environment and accessibility for patients and families with disabilities.

Vision

To be a leading voice in creating safe, accessible, and welcoming spaces that allow all individuals to receive the highest quality of care without barriers.

Values

ACCESS values integrity, accountability, and passion about the improvement of accessibility in Kaleida Health facilities.

Committee Expectations

• Attend quarterly meetings (virtually, by phone, or in-person)
• Sign a 1 year contract with 75% attendance (i.e. 3 out of 4 meetings throughout the year)
• Engage in discussions with mutual respect and empathy
• Share insight and information about your experience in ways others can learn from
• Be responsive to e-mail, text, and/or meetings

Your Information

Full Name

Please enter your full name

Phone Number/Contact Number

Please enter your phone number

Pronouns (She, He, They, Ze, Xe)

Please enter your preferred pronoun

Email Address

Please enter your email address

Do you prefer emails, texts or phone calls? Select a contact type Phone Calls Emails Text Messages No Preference

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Best time of day to contact you? Select a timeframe Morning Daytime Afternoon No Preference

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Demographic Information

What is your race?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

Two or more races

White

Prefer not to answer

Please select an option

What is your age group?

Under 21

21 to 34

35 to 44

45 to 55

55 or older

Prefer not to answer

Please select an option

What is your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Please select an option

What is your gender identification?

Male

Female

Female-to-Male (FTM) Transgender

Male-to-Female (MTF) Transgender

Genderqueer or non-binary

Gender non-conforming

Other

Please select an option

Do you think of yourself as?

Straight, heterosexual

Lesbian, gay, or homosexual

Bisexual

Something else

Prefer not to answer

Please select an option

Additional Information

Based on your hospital/medical experiences, what are some specific things that healthcare professionals can do differently to be better help patients?

This field can not be blank

(Optional) How did you hear about ACCESS?

Have you or a loved one received care at a Kaleida Health facility in the last year?

Yes

No

Please select an option

Submit

Kaleida Health is an equal opportunity and affirmative action employer. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, religion, sex, national origin, citizenship status, creed, gender, gender identity or expression, sexual orientation, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.