1.Please provide your full name.

2.Please provide your email address.

3.Region

Eastern (All areas east of Highway 400 (excluding City of Toronto) and South of a line drawn from Parry Sound through Huntsville to Pembroke)

Western (All areas west of Highway 400 (excluding City of Toronto) and South of a line drawn from Parry Sound. Niagara and Bruce Peninsula are also in this region)

Northern (All areas north of a line drawn from Collingwood to North Bradford, along the shores of Lake Simcoe through Huntsville to Pembroke, excluding the Bruce Peninsula)

Central (City of Toronto)

Other (please specify)

4.How old are you?

Less than 16 years

16 - 19 years

20 – 29 years

30 - 39 years

40 – 49 years

50 – 59 years

60 - 69 years

70 - 79 years

80+ years

I prefer not to answer

5.Which gender do you identify with?

Cis Woman

Cis Man

Trans woman

Trans man

Two-Spirit

Non-binary

Intersex

I prefer not to answer

Other (please specify): ___________

6.With which sexual orientation do you identify?

Lesbian/Gay

Straight

Queer

Bisexual

Pansexual

Asexual

I prefer not to answer

Other (please specify):

7.Do you belong to any of the following ethno-racial identities? (Choose at least one box. You can choose more than one if appropriate)

Métis People

First Nations People

Inuit People

African, Caribbean and Black (ACB)

East Asian/ South Asian

Caucasian/ White

Latinx/Latine

Middle East and North African People (MENA)

I prefer not to answer

Other (please specify)

8.Do you identify with any of the following groups? (Please check all that apply)

Sex worker

Person who uses drugs

Person living with a disability (not HIV/AIDS)

Newcomer or new immigrant to Canada (within last 3 years)

Refugee or asylum seeker

Migrant worker

international Student

Youth (Under 30)

Incarcerated or previously incarcerated

I prefer not to answer

I don't identify with any of these

Other (please specify)

9.For how long have you been living with HIV/AIDS?

Less than 1 year

1 - 5 years

6 - 10 years

11 - 15 years

16 – 20 years

21 - 30 years

30+ years

I am not living with HIV/AIDS

I am unsure of my HIV/AIDS status

I prefer not to answer

10.Why do you want to contribute to the Ontario AIDS Network by serving on the Advisory Committee?

11.What interests you most about the Committee?

12.tell us why you think the Advisory Committee is important to the Ontario HIV/AIDS Movement

13.Have you graduated from the Positive Leadership Development Institute (PLDI) core training or another recognized capacity-building program delivered in Ontario?

Yes

No

List

14.Are you willing to serve a 2-year term and regularly scheduled Zoom meetings?

Yes

No

15.Please provide the name of the OAN member or affiliate organization that endorses your application. Wording on any affiliate organization

16.Would you like to tell us anything else?