General Information

IMPORTANT: You must be between the ages of 18-24 and not currently attending TRUST or the Trans Youth Group to begin volunteering with the Leadership Project.

DISCLAIMER: This information will be kept strictly confidential. It will only be used by CANDLE staff, and no identifying information will be shared outside of the Youth Pride Initiative at CANDLE, unless the client is in danger or others are threatened or harmed by the client.

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* 1. Today's Date:

Ex: 07/10/2014

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* 2. Name:

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* 3. Date of Birth:

Ex: 07/10/2014

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* 4. Ethnic/Racial Identity:
(Check all that apply.)

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* 5. Gender:
(Check all that apply.)

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* 6. The pronouns you use are:
(he/him/his
she/her/hers
they/them/theirs
Ze/hir/hirs
Ze/zir/zirs
etc.)

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* 7. Sexual Orientation:
(Check all that apply.)

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* 8. Home Address:

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* 9. Which is the best way to contact you about events and volunteer opportunities?

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* 10. Which of these are shared with other people?

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* 11. How did you find out about this group?

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* 12. In case of emergency, what responsible person would you like us to contact?
(No one will be contacted unless you are a danger to yourself or others.)

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* 13. Does this person know that you go to a group at CANDLE? What should we say if we need to call?

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* 14. Have you attended Common Threads as a participant before?

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