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1. What is your agency type? (Required.)

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2. What is the name of your organization? (Required.)

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3. What city/town and zip-code is your agency located in? (Required.)

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4. Is your agency currently offering any programming/activities specifically designed for LGBTQ+ Older Adults? (Required.)

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5. If yes, what are you offering? (check all that apply)

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6. If yes, what is the frequency?

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7. What barriers/challenges has your agency faced, or anticipates facing in developing/offering LGBTQ+ programming? (check all that apply)

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8. Is your agency interested in working with OutstandingLife to increase programming for LGBTQ+ older adults in your service area? (answering this question affirmatively is not committing)

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9. Let's start a discussion, who is the best person for OutstandingLife to contact at your agency? First/Last Name

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10. What is their title?

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11. What is their email address?

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12. What is their phone number?

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13. Please use this space to convey any additional information you would like OsL to know.

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