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* 1. What role do you have in your family or household (check all that apply)?

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* 2. How do you identify your sexual orientation and gender identity? (Check all that apply)

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* 3. What best describes your relationship status (check all that apply)?

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* 4. What are the ages of the children in your family? (Check all that apply)

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* 5. How was your family formed? (Check all that apply)

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* 6. Which support or resources would you be most interested in receiving or bringing to your community? (Check all that apply)

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* 7. Based on your above-selected answers, please use this space to describe in more detail the kinds of resources that would be most relevant and helpful to you and/or your family.

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* 8. Which LGBTQ+ groups, (in person, virtual and/or social media), agencies, and/or nonprofit organizations are you engaged with (follow on social media, receive their newsletters, attend events, etc.)?

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* 9. Do you feel like you are part of the local LGBTQ+ community?

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* 10. If you would like to receive more information about the LGBT Network's LGBT Families Program (upcoming events, newsletter, etc.), please share your information (all info will remain private). Thank you!

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