TDOR RSVP

Survey

All Information is confidential and data will be used to access grants to fund the Transgender Health and Wellness Center.

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* 1. Are you a volunteer or an attendee?

Volunteer

Attendee

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* 2. Which vigil will you be attending?

Palm Springs

Riverside

Victorville

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* 3. Will you be attending our fundraiser, Equality & Equity: The TW&WC Transgender Mixer?

Yes

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* 4. Name

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* 5. Location

City/Town *

State/Province

ZIP/Postal Code *

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* 6. Age

17 or under

18-24

25-30

31-40

41-50

51-60

61-70

71 or above

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* 7. Race/Ethnicity

Black or African American

Indigenous/Native American

Latinx/Hispanic

White

Asian

Native Hawaiian/ Pacific Islander

Other (please specify)

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* 8. Ethnicity

Hispanic, Latino/a or Spanish Origin

Not of Hispanic, Latino/a or Spanish Origin

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* 9. Religion

Christianity

Islam

Buddhism

Hinduism

Indigenous/Native religion or practices

Nonreligious/Atheist

Agnostic

None of the above

Other (please specify)

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* 10. Sexual Orientation

Lesbian

Gay

Bisexual

Heterosexual

Queer

Asexual

Pansexual

Other (please specify)

Question Title

* 11. What is your gender identity?

Trans Woman

Transfem

Cis Woman (someone who identifies with their gender assigned at birth)

Trans Man

Transmasc

Cis Man (someone who identifies with their gender assigned at birth)

Non-binary

Agender

Genderfluid

Genderqueer

Two-spirit (reserved for those of Indigenous background)

Other (please specify)

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* 12. What is your annual income?

No income

$9,999 or less

$13,000 or less

$25,000 or less

$35,000 or less

$35,001 or more

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* 13. What is your current housing status?

Live in a stable housing without fear of being evicted

Live in a unstable housing with fear of being evicted

Do not have a functioning home or are currently homeless

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* 14. What is your email address?

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* 15. Would you like to receive information about the services we provide?

Yes

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* 16. Would you like to be notified for future events?

Yes

TDOR RSVP

Survey

Question Title

* 1. Are you a volunteer or an attendee?

Question Title

* 2. Which vigil will you be attending?

Question Title

* 3. Will you be attending our fundraiser, Equality & Equity: The TW&WC Transgender Mixer?

Question Title

* 4. Name

Question Title

* 5. Location

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* 6. Age

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* 7. Race/Ethnicity

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* 8. Ethnicity

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* 9. Religion

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* 10. Sexual Orientation

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* 11. What is your gender identity?

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* 12. What is your annual income?

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* 13. What is your current housing status?

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* 14. What is your email address?

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* 15. Would you like to receive information about the services we provide?

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* 16. Would you like to be notified for future events?

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* 17. Comments/Suggestions