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You are being asked to self-identify/volunteer to participate. If you find some of the language difficult to understand, please ask your Student Resource Specialist (Chris Castillo) about this form. Any information that is obtained in connection with this survey and that can be identified with you will remain confidential.

The purpose of this survey is to outreach to our LGBTQIA+ and Undocumented Students at Norco College.

The Unity Zone supports holistic success (academic, personal, and professional), create equitable opportunities, career education, scholarships, resources, and fosters safe/brave spaces for LGBTQIA+ Students, AB 540, Undocumented Student, mixed-status household families, and allies at Norco College.

Don't hesitate to get in touch with Christopher Castillo (he/him/el) for more information relating to resources or the Unity Zone via email at Christopher.castillo@norcocollege.edu, call (951) 739-7873, or stop by the Unity Zone CSS 216

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* 1. Preferred First and Last Name

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* 2. Student ID Number

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* 3. Student Email 

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* 4. Phone Number

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* 5. If we need to contact you, which do you prefer?

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* 6. The foreseeable risks in this survey can include emotional triggering and emotional distress due to the personal set of questions. *Current resources to help mediate your needs can be provided.

You do not need to comment.

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* 7. What is your sexual identity?

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* 8. What is your Gender Identity?

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* 9. If you identify with the LGBTQIA+ community, would you like to be contacted about student services on campus available to you?

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* 10. Do you identify with one of the following?

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* 11. If you identify with the Undocumented Community, would you like to be contacted about student services on campus available to you?

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