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1. Demographic Information

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2. Gender:

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3. Sexual Orientation:

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4. Which Racial/Ethnic groups do you identify as (check all that apply)

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7. How did you hear about KGA? (check all that apply)

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8. Why are you interested in joining KGA's Young Men's Empowerment Program?

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9. What does brotherhood mean to you? And why is it important?

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10. How would you contribute to building a powerful brotherhood with other young men and young women at KGA?

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11. What is an important issue that young Khmer and/ or Southeast Asian men face in your community?

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12. We want to know a little more about you. Anything else you want to share with us about yourself (ex: qualities,interests, goals, life struggles, etc)?

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