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

Aging Services Access Point

Council on Aging, Senior Center, Community Center

LGBTQ Organization

Other (please specify)

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

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

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

Yes

No

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

LGBTQ+ Lunch/Supper Club

Peer Support Group

Workshops and/or Lectures

Peer Social Hour

LGBTQ+ Pride Events

Other (please specify)

Not Applicable

6.If yes, what is the frequency?

Weekly

Monthly

Quarterly

Semi-annually

Annually

Other (please specify)

Not Applicable

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

Staffing shortage

Low attendance

Lack of resources and funding

Access to appropriate programs/activities/presenters

Lack of community partners

Finding a safe welcoming space

Other (please specify)

Not Applicable

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)

Yes

No

Maybe

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

10.What is their title?

11.What is their email address?

12.What is their phone number?

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