Project Bravery Youth & Young Adult Intake
This form is meant to be filled out by youth ages 14-18, young adults ages 18-24 or LGBTQIA2S+ families seeking resources and support.
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Instructions
These questions help us get to know you a little bit. They also help us figure out what young LGBTQIA2S+ people and families in our community need so that we can try and make Bravery, and our community, a better place.

Some questions are required, but most of them are optional. These questions help us learn more about LGBTQIA2S+ young people and families in our community. They also help us tell other people why spaces like Bravery are important. You don't have to answer an optional question if you aren't comfortable.

We will not share any personal information that could identify you with anyone outside of our organization (Olalla Center). Demographic information (race/ethnicity, gender identity, sexual orientation, housing status, etc.) may be shared through grant reporting or presentations, but your identity will remain completely anonymous. Your name and contact information will never, ever be shared.  No information you provide will be used against you in any way.
How old are you? *
I learned about Project Bravery from...
 *
Required
Is this your first time in a Bravery space? (Digitally or physically.)
 *
Contact Information
Once we receive your form, how should we reach out to you?
First and last name (What do you like to be called?)
 *
Pronouns *
Email or social media where we can reach you (after you submit your form, Bravery staff will reach out to you):
 *
Your preferred method of contacting:
 *
What Bravery resources and/or programs are you interested in? You can pick as many as you'd like.
Demographics
These questions are optional, but collecting this type of information helps us get a better picture of the people and needs in our community. We really appreciate it! If you aren't comfortable answering certain questions, or any questions, that's okay.
What is your race or ethnicity? Please check all terms that apply to you. If your race or ethnicity is not listed, please write it in the "other" box so that we can work to make our list more inclusive.
Do you have a safe place to live?

Clear selection
What is your living situation? (Check all that apply)
Do you have access to enough food to eat?
Clear selection
Do you have health insurance?
Clear selection
What is the zipcode where you live?
Sexual Orientation
An emotional, romantic or sexual attraction to other people. We know that sexual orientation can be different from romantic orientation, and that it can get complicated. For the purposes of this form, please choose the term(s) that you feel best describe your orientation.
Please select the term(s) that best describe your sexual orientation:
Gender Identity
Gender identity is who we know ourselves to be on the inside.

Cisgender means you identify with the gender you were assigned at birth.

Transgender is an umbrella term that covers lots of different identities. It basically means that you do not identify with the gender you were assigned at birth.

For the purposes of this form, please select what term(s) best describe your identity.
Please select the term(s) that best describe your gender identity:
School
Are you currently in school or college?
Clear selection
I am currently...
Clear selection
What school do you go to?
How safe do you feel at your school?
Very unsafe
Very safe
Clear selection
How safe do you feel in the community where you live?
Very unsafe
Very safe
Clear selection
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