www.surveymonkey.com
Open in
urlscan Pro
108.157.4.114
Public Scan
Submitted URL: https://clicks.socialchorus.com/ls/click?upn=pg2UbbZRoIwiAdvWKwaHsoLqoQImHbUrwwX1rsWcSFhXxcfG9-2FcHWc85yOrxGCGjd1Z4_uo-2BJHBGMuL...
Effective URL: https://www.surveymonkey.com/r/MHEDIERG
Submission: On July 18 via api from US — Scanned from DE
Effective URL: https://www.surveymonkey.com/r/MHEDIERG
Submission: On July 18 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: surveyForm — POST
<form name="surveyForm" action="" method="post" enctype="multipart/form-data" novalidate="" data-survey-page-form="">
<div class="questions clearfix">
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-67129880" data-qnumber="1" data-qdispnumber="1" data-question-id="67129880" class=" question-open-ended-single qn question single">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-67129880" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 1<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Your name</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_67129880" data-question-id="67129880" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-size="50" data-labeledby="question-title-67129880">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-67129880" id="67129880" aria-required="false" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="67129880" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-67129943" data-qnumber="2" data-qdispnumber="2" data-question-id="67129943" class=" question-open-ended-single qn question single">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-67129943" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 2<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Your work location</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_67129943" data-question-id="67129943" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-size="50" data-labeledby="question-title-67129943">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-67129943" id="67129943" aria-required="false" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="67129943" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-67867828" data-qnumber="3" data-qdispnumber="3" data-question-id="67867828" class=" question-open-ended-single qn question single">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-67867828" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 3<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Your title</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_67867828" data-question-id="67867828" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-size="50" data-labeledby="question-title-67867828">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-67867828" id="67867828" aria-required="false" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="67867828" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-67129980" data-qnumber="4" data-qdispnumber="4" data-question-id="67129980" class=" question-open-ended-single qn question single">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-67129980" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 4<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Memorial Hermann email address</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_67129980" data-question-id="67129980" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-size="50" data-labeledby="question-title-67129980">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-67129980" id="67129980" aria-required="false" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="67129980" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="multiple_choice_vertical" data-rq-question-type="multiple_choice_vertical" class="question-container
">
<div id="question-field-67130660" data-qnumber="5" data-qdispnumber="5" data-question-id="67130660" class=" question-multiple-choice qn question vertical">
<h3 class="screenreader-only">Question Title</h3>
<fieldset class=" question-fieldset">
<legend class="question-legend">
<h4 id="question-title-67130660" class="
question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 5<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Please select all ERGs you'd like to join.</span>
</h4>
</legend>
<div class="question-body clearfix notranslate ">
<div class="">
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67130660_547146881" name="67130660[]" type="checkbox" class="checkbox-button-input " value="547146881">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67130660_547146881">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Black/African-American </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67130660_547146882" name="67130660[]" type="checkbox" class="checkbox-button-input " value="547146882">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67130660_547146882">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Disability </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67130660_547146883" name="67130660[]" type="checkbox" class="checkbox-button-input " value="547146883">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67130660_547146883">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> LGBTQIA+ </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67130660_547146884" name="67130660[]" type="checkbox" class="checkbox-button-input " value="547146884">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67130660_547146884">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Veterans </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67130660_552277499" name="67130660[]" type="checkbox" class="checkbox-button-input " value="552277499">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67130660_552277499">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Women </span>
</label>
</div>
</div>
</div>
</div>
</fieldset>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="multiple_choice_vertical" data-rq-question-type="multiple_choice_vertical" class="question-container
">
<div id="question-field-67892759" data-qnumber="6" data-qdispnumber="6" data-question-id="67892759" class=" question-multiple-choice qn question vertical">
<h3 class="screenreader-only">Question Title</h3>
<fieldset class=" question-fieldset">
<legend class="question-legend">
<h4 id="question-title-67892759" class="
question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 6<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> We received interest in forming ERGs for the communities listed below. Please indicate if you are interested in leading or supporting the efforts to potentially launch these proposed ERGs in January 2023.</span>
</h4>
</legend>
<div class="question-body clearfix notranslate ">
<div class="">
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67892759_552278807" name="67892759[]" type="checkbox" class="checkbox-button-input " value="552278807">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67892759_552278807">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Hispanic and Latino/a </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67892759_552278808" name="67892759[]" type="checkbox" class="checkbox-button-input " value="552278808">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67892759_552278808">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Asian and Pacific American </span>
</label>
</div>
</div>
<div class="answer-option-cell
">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="67892759_552278809" name="67892759[]" type="checkbox" class="checkbox-button-input " value="552278809">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="67892759_552278809">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Young Professionals/Early Careers </span>
</label>
</div>
</div>
</div>
</div>
</fieldset>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_essay" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-67893004" data-qnumber="7" data-qdispnumber="7" data-question-id="67893004" class=" question-essay qn question essay">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-67893004" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 7<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> If you'd like to propose an ERG, please enter the details of the proposed group and a member of the Memorial Hermann Equity, Diversity and Inclusion team will be in contact shortly.</span>
</h4>
<div class="question-body clearfix notranslate ">
<div class="textarea-container">
<textarea aria-labelledby="question-title-67893004" id="67893004" name="67893004" class="textarea" spellcheck="true" rows="3" cols="50" data-sm-textarea="" maxlength="20000"></textarea>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="survey-submit-actions center-text clearfix">
<button type="submit" data-submit-page-button="" class="btn small done-button survey-page-button user-generated notranslate"> Done </button>
</div>
<input type="hidden" id="survey_data" name="survey_data"
value="4FoTYerhlqpl9PSGmuD5IZxWm2b4l_2FCkU_2BHOu1so47IziWh9tzygJwm37a5PJKvCoUnwePHlnF_2BQ83hPKkbo5yP9foNNbYRRpT1GFXXOWFa2SIGhvh2TH6Zzvb9kFkbHvXrJhNs07ZbPFEaFHy_2Ff1oMRdkbACOa3MdXIR8W00EzxvJh8Z6PpDUCgVMTnl0_2B1xTPsx_2Fij7r8gbpqfQeZVjhSY_2BNroKcKKymQRs_2FdKwuXlk3YyD1Ikrzanx2OOtUA_2FIV7vRf14xNxl5Wmvi2k1gq7JWYlpeSIN_2FKwbx70TleR155o_2FB_2BGrcS5szC5LP4_2BKZAZdzr2gZIU8phejCZhZcVDr6Iu276Rgo4_2FGmOiHqwQmHoWL2L3UBJf5rAYFJexdKOaGWASu97zwPrm5poLYVEk5_2BBHCP8McEA0D2aYkbT4vW22LkMOnpmU8higseuFXjvlqHRnr3CwPVQQ4qY5maV6TFeD4V7WWkR5e2yprBhkCCVrKy_2B44OBZ7DVUjp1zgzyt0zqtNeVPi9yAn6EZyp24a39RR1bQXWNhhzF6BmS3oecz6BT4Ai_2BLs_2BNwR9xGD">
<input type="hidden" data-response-quality="" id="response_quality_data" name="response_quality_data" value="{}">
<input type="hidden" id="is_previous" name="is_previous" value="false">
<input type="hidden" id="disable_survey_buttons_on_submit" name="disable_survey_buttons_on_submit" value="">
</form>Text Content
JOIN A MEMORIAL HERMANN EMPLOYEE RESOURCE GROUP QUESTION TITLE * 1. YOUR NAME QUESTION TITLE * 2. YOUR WORK LOCATION QUESTION TITLE * 3. YOUR TITLE QUESTION TITLE * 4. MEMORIAL HERMANN EMAIL ADDRESS QUESTION TITLE * 5. PLEASE SELECT ALL ERGS YOU'D LIKE TO JOIN. Black/African-American Disability LGBTQIA+ Veterans Women QUESTION TITLE * 6. WE RECEIVED INTEREST IN FORMING ERGS FOR THE COMMUNITIES LISTED BELOW. PLEASE INDICATE IF YOU ARE INTERESTED IN LEADING OR SUPPORTING THE EFFORTS TO POTENTIALLY LAUNCH THESE PROPOSED ERGS IN JANUARY 2023. Hispanic and Latino/a Asian and Pacific American Young Professionals/Early Careers QUESTION TITLE * 7. IF YOU'D LIKE TO PROPOSE AN ERG, PLEASE ENTER THE DETAILS OF THE PROPOSED GROUP AND A MEMBER OF THE MEMORIAL HERMANN EQUITY, DIVERSITY AND INCLUSION TEAM WILL BE IN CONTACT SHORTLY. Done Powered by See how easy it is to create a survey. Privacy & Cookie Notice Javascript is required for this site to function, please enable.