Totally outRIGHT Toronto Intake Spring 2018 (actoronto.org/to)

All the information collected in this survey is confidential and will be kept private

Totally outRIGHT is a 4-day series of workshops offered in Toronto for any gay, bi, queer cis or trans men aged between 18 and 29. This program takes place at ACT, a few steps away from Wellesley TTC station, on Saturday May 26, June 2, 9 & 16 from 10 am to 5 pm. We ask participants to attend all 4 sessions if possible.

This free program is open to young gay, bi, two-spirit or queer cis and trans men of any background, ethnicity, ability, or HIV status.

Food and tokens (or presto card for GO transit) will be provided.

Please complete this short survey and one of the program's staff will contact you in the next few days to schedule an intake and information session. This session will ideally take place at the ACT office, but can be scheduled over the phone if transportation is an issue.

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* 1. Please provide your name:
(This name will be used on all documents including your graduation certificate, unless you specify another name you would like us to use prior to graduation)

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* 2. Nickname or preferred name:
(if different than above)

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* 3. Which pronouns do you use?
(e.g. he/him, them/them)

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* 4. What is your age?

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* 5. What is your birth date?

Date

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* 6. Please provide an email address and phone number.

Email:

Phone:

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* 7. Which way would you prefer Totally outRIGHT staff to contact you for the intake?

Phone call - you may leave a message

Phone call - please do not leave a message

Text

E-mail

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* 8. In a few short sentences, explain why you would be interested in participating in a health & leadership program for young gay / bi / queer cis and trans men:

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* 9. If you have monetary restrictions that would prevent you to be a participant in Totally outRIGHT, you may be eligible to a small accessibility grant to allow your participation. Check "yes" if you'd be interested in learning more, or to apply.

Yes

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* 1. Please provide your name: (This name will be used on all documents including your graduation certificate, unless you specify another name you would like us to use prior to graduation)

Question Title

* 2. Nickname or preferred name: (if different than above)

Question Title

* 3. Which pronouns do you use? (e.g. he/him, them/them)

Question Title

* 4. What is your age?

Question Title

* 5. What is your birth date?

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* 6. Please provide an email address and phone number.

Question Title

* 7. Which way would you prefer Totally outRIGHT staff to contact you for the intake?

Question Title

* 8. In a few short sentences, explain why you would be interested in participating in a health & leadership program for young gay / bi / queer cis and trans men:

Question Title

* 9. If you have monetary restrictions that would prevent you to be a participant in Totally outRIGHT, you may be eligible to a small accessibility grant to allow your participation. Check "yes" if you'd be interested in learning more, or to apply.

Question Title

* 10. Let us know of any food restrictions / allergies or accessibility needs:

* 1. Please provide your name:
(This name will be used on all documents including your graduation certificate, unless you specify another name you would like us to use prior to graduation)

* 2. Nickname or preferred name:
(if different than above)

* 3. Which pronouns do you use?
(e.g. he/him, them/them)