1. Demographic Information

2. Gender:

3. Sexual Orientation:

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

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

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

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

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

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

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)?