JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Brooklyn Ghost Project
BGP Enrollment
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Check yes, if you understand that in order to qualify for the Brooklyn Ghost Project programs and opportunities one must be a person of color living in one of the five boroughs of New York City and identify as either transgender or non-binary.
*
Yes! I am a POC that identifies as Transgender/non-binary and I live in NYC.
No! I do not meet the qualification standards, but I would still like to volunteer my time/offer my support
Required
Email Address (optional)
Your answer
Last Name
*
Your answer
First Name
*
Your answer
Pronoun
*
She/Her/Hers
He/Him/His
They/Them
Ze/Zey/Zim
Non-binary
In which borough do you live?
*
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Address: Street
*
Your answer
Address: City
*
Your answer
Address: State
*
Your answer
Address: Apt #
Your answer
Address: Zipcode
Your answer
Phone number
*
Your answer
AGE
*
Your answer
RACE
*
BLACK
DOMINICAN
LATIN
ASIAN
OTHER
Income (what is your yearly financial income)
*
I make less than $15,000 a year
I make less than $25,000 a year
I make more than $25,000 a year, however, I am financially responsible for more than myself
Do you receive any type of government assistance? (this includes EBT, SSI, NYCHA Housing, Hasa, and HUD)
*
Yes
No
Are you currently employed?
Yes
NO
Clear selection
Have you ever been terminated from (or passed over for) a job you were qualified for because of you gender identity?
*
Yes
No
Maybe
Do you have life insurance
*
Yes
No
I Am Not Sure
Would you to protest or march in protest against the violent murrder of Black Trans Woman?
*
Yes
No
Maybe
In a short paragraph (3 or 4 sentences), share with us, your dreams and life aspirations for the near furture?
*
Your answer
Emergency Contact Name (first and last)
*
Your answer
Emergency Contact Phone Number
*
Your answer
Please submit a social media link to an account you own that has a picture and was created more than 6 months ago as self-verification.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
