RE-Imagine Justice MD Interest form

Interested in working with us? Please complete the form below, and we will get back to you within 2 business days.
First name
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Last name
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Company Name
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Email
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How'd you hear about us?
LinkedIn
Instagram
Twitter
Facebook
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Website
Other
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What services are you interested in?
Equitable Empathy Coaching Program
Workshops
Speaking Engagements
Something else
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Submit

Workshops
Which workshop are you interested in?
Mindset Shifts Workshop (2 hour workshop that focuses on understanding biases and intentionally shifting your mindset)
Equitable Empathy Workshops (2 hour workshop Understanding how to relate to others based on their intersecting needs and identities)
Other
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How many people will be joining this workshop?
Our workshops are for groups of 25 people max
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Our workshops are for groups of 25 people max
Who will be attending this workshop? 
Executive Leadership
Middle Managers
Staff/Employees
Board Members
Council Members
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What is your budget for this workshop?
Under $3,000
$3,000 - $5,000
$5,000 - $10K
$10K+
We don't have an established budget, but we have the funds and flexibility to hire the best
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What would make you feel like this workshop was successful?
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Is there any additional information you would like to add that you think would be helpful for us to know?


Speaking Engagements

Tell us more about the event that you are planning. 
What content would you like for us to cover and how long will this speaking engagmeent be?
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What content would you like for us to cover and how long will this speaking engagmeent be?
What is the tentative date of the speaking engagement?
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What do you hope the audience walks away with after attending this talk? 
Consider what lessons you'd like for your audience to learn after attending this talk.
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Consider what lessons you'd like for your audience to learn after attending this talk.
What is your budget for the speaking engagement
We don't have the funds in our budget at the moment
Under $1,000
$1,000 - $2,500
$2,500 - $5,000
$5,000 - $10,000
$10K+
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Equitable Leadership Coaching Program

This is a three-month intensive group coaching program where you'll work with Dr. Danisha and her team to unlearn and accept without discrimination. You will learn how to effectively communicate with intentionality and clarity, gain tools to overcome the challenges of change, and develop skills and strategies to lead equitably within your organization and community. 

Here are some examples of topics we'll work through 
Vulnerable Authority
Radical Mindset Shifts 
How to receive feedback with empathy and grace
Emotional Intelligence 
Bidirectional Feedback 
Equitable Empathy

If this sounds like something you're interested in, fill out our short application below.

Tell me a little about yourself. What do you currently do for work, and how long have you been in your current role?
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What are your top 3 biggest struggles or areas of concern when it comes to understanding DEI-related topics (ex: diversity, allyship, equity, intersectionality, etc.)?
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What have you done so far to help you overcome the things you're struggling with? Why do you think your solutions haven't worked?
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What qualities are you looking for in a coach? What made you interested in working with me?
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What makes you a great client to work with?
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What do you hope to walk away with after the coaching program is completed? 
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What would make you feel like this was a great investment? 
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I will only work with you if I'm confident I can help you accomplish your goals. Our coaching program is $4,997.97 (with payment plans if needed). If this is within your budget, are you ready to invest?
Yes, I am ready to invest
I still have some questions, and would like to talk with Dr. Danisha before I move forward
This is out of my budget and would like more information about your 60-minute session.
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Any other questions you have for me, or is there anything else I should know?