eQuality Resource Map Inclusion Form

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Please fill out this form to add your organization, program, or agency to the CCYJ eQuality Resource Map.

This map is used to help youth-serving professionals, family members, and young people connect with LGBTQ+ affirming places in their immediate area.

If there are any questions about this form or about the eQuality Resource Map Project, please reach out to Becca Guest at bguest@ccyj.org.

Organization/Agency Name *

Program Name (if applicable)

Program Description (if applicable)

Do you offer any specific services for LGBTQ+ youth?
*

Yes

What specific services to LGBTQ+ youth are offered?

Are LGBTQ+ youth welcome in the current services your organization provides, even if they are not LGBTQ+ specific?
*

Yes

Does your screening/intake paperwork offer gender affirming questions where youth are able to share their SOGIE (sexual orientation, gender identity, gender expression) and/or pronouns?
*

Yes

My organization does not require or use screening/intake paperwork for access to our services..

Does your building, program space, or offices have gender neutral or private restrooms?

Yes

Clear selection

Do your building, program space, offices, website and/or social media have imagery or language (rainbow/gender/sexual orientation flags, nondiscrimination posters) to let LGBTQ+ youth know you’re a welcoming space?
*

Yes

Please provide organization's address (put in n/a, if there is no address) *

Please provide a contact phone number and/or email address. *

Please provide organization website and/or relevant social media information. *

Please provide a non-named email address in the event that other emails to your organization bounce there is a need to contact your organization. (For example, support@ccyj.org is monitored by several team members.)
*

Are there other local resources in your area that should go on our Resource Map for LGBTQ+ youth and young adults?

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