Stand with Trans, Oakland County Service Provider Questionnaire

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Stand with Trans, a 501c3 nonprofit, has received a grant to help us create a directory of transgender-affirming providers in Oakland County for transgender youth (through age 24) and their families. Participation is optional, and there will not be a negative impact if you indicate that you would not like to be on our directory or provide services to this community.

Please contact Logan@standwithtrans.org with any questions, comments, or concerns. Thank you for taking the time to complete this questionnaire!

Email *

We will have two directories--one is public facing, and will exist on Stand with Trans' Lifeline Library. Given the current political climate, we understand that some providers may not be comfortable being publicly listed. The other directory will be an internal-use-only document for Stand with Trans staff who are assisting community members with recommendations.

If you consent to being listed in one of the directories, please fill out the following questions about your practice.

I consent to being listed in the public-facing Lifeline Library and the internal directory

I consent to only being listed in the internal directory

I do not consent to being listed in either directory/ do not wish to participate

What is your name? *

I am a(n)... *

Barber

Hairstylist

Lawyer

Attorney

Childcare Provider

Business Owner (please specify in "other")

Another type of professional (please specify in "other")

Other:

Required

Is your business, facility, or practice in Oakland County? *

Yes

Do you feel comfortable serving transgender individuals and their families? *

Yes, I am comfortable with that

Maybe, I don't feel that I am fully prepared to serve that population at this time, but I'd like to

Other:

If you are comfortable serving transgender individuals and their families, what age ranges are you able to serve? *

0-6 years old

6-12 years old

12-16 years old

16-18 years old

18-24 years old

24+ years old

Required

Please describe the services you are able to provide to this community *

Please describe any experience you have with the transgender community--have you served transgender folks before, do you or someone close to you have lived experiences as a trans person, do you feel relatively knowledgeable about the topic, etc. *

What is the name of your business? *

What is the best email for people to reach your business? *

What is the best phone number for people to reach your business? *

Business Address Line 1: *

Business Address Line 2:

Business City: *

Business Zip Code: *

Is there anything else you think we should know? (Languages available, elaborating on an earlier answer, etc.) *

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