The purpose of this survey is to collect information about organizations that provide services for Lesbian, Gay, Bisexual, and Transgender (LGBT) veterans/service members. CalVet will use this information to create a resource guide to connect LGBT veterans/service members to services.

All information you provide will be used only for the purpose of connecting veterans/service members to services, gaining a better understanding of available services for LGBT veterans/service members, and providing aggregate estimates of the number of LGBT veterans/service members needing services.

Please note that answers are required for questions with an asterisk (*) .

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* 1. Is it okay if the information you provide is published in a resource guide?

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* 2. Name of person filling out this form (first name, last name)

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* 3. Title of person filling out this form

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* 4. Name of your organization

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* 5. Name of Public Contact for organization

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* 6. Street Address

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* 7. City, State, Zip

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* 8. Public Email

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* 9. Public Phone Number

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* 10. Website

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* 11. Days and Hours of Operation

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* 12. Number of Years in Business

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* 13. Number of Staff Members

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* 14. Is your organization government, nongovernment/nonprofit, or for profit? (check one)

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* 15. Is the primary mission of your organization to serve veterans/service members, LGBT individuals, or both?

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