Avenidas LGBTQ Senior Initiative and Youth Space Friendly Visitor Pen Pal Program

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* 1. What is your first and last name?

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* 2. What is your age range?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. What are your Pronouns?

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* 4. How do you Identify in the LGBTQ+ Community

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* 5. Who would you prefer to be connected with?

Any person of the LGBTQ+ Community

Someone who shares the gender Identity and/or the same sexual orientation with me.

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* 6. How do you prefer to correspond with your new friend? please rank from preferred method to least preferred.

Mail

Email

Phone

Video Chat

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* 7. What is your phone number?

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* 8. What is your mailing address?

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* 9. What is your email address?

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* 10. Do you have any requests or concerns that we should be aware of that would assist us in making a successful match for you?