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QTBIPOC Needs Assessment Presentation Registration Form
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Name you go by:
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Your answer
Email Address:
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Your answer
What best describes you? I am a...(check all that apply)
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QTBIPOC Community Member (Queer/Trans Black, Indigenous, Person of Color)
Non-POC LGBTQIA+ Community Member
LGBTQIA+/BIPOC Community Ally
Medical Professional
Mental Health Professional
Social Services Professional
Non-Profit Employee
Community Organizer
Academic and/or Researcher
Philanthropist or Foundation Employee
Other:
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Where do you live? (City, State)
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Place of employment (optional)
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How did you hear about this presentation (optional)
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