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Connections: Healthy Relationships with Family, Friends, and Partners

Connections is a live online course that consists of 10 classes sponsored by Independence Northwest. This class is about relationships and sexual health and will help you reach out and build stronger connections with the people you care about. The Connections class will give you tools to be safe and happy in your relationships.

Please note that attendance at every class in the series is important because each class builds on the one before.

If you have any questions, don't hesitate to reach out to one of the instructors (Corinne or Alice) by emailing us at connectionspeople@gmail.com.

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* 1. What is your name?

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* 2. Please share your contact information with us.

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* 3. If you would like to add an additional contact for us to communicate with (such as a family member, support person, provider, or friend) please share their name, phone, and email address below.

If not, just skip this question and go to the next one.

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* 4. What is your brokerage Personal Agent's name?

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* 5. Which brokerage do you receive services from?

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* 6. What is your Personal Agent's email address?

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* 7. Which online orientation will you be attending?

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* 8. What is your age?

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* 9. What are your preferred personal pronouns?

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* 10. In your own words, why do you want to take this class?

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* 11. What types of relationships do you want to learn more about?

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* 12. Our class will be held virtually. You will sign in on your computer at class time and join several other brokerage customers and the instructor. We are going to use Zoom for the class. What experience do you have using Zoom to talk with people, like your Personal Agent, support providers, or friends?

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* 13. For the class to work well virtually and on zoom, these things are needed:

A computer or tablet (iPad) with a screen large enough to see several people on Zoom: It is important that you can see the instructor and the other students during the class, so the screen needs to be big enough for us to see each other’s faces.  A computer is best, but a tablet or iPad can also work.

A camera, microphone and speakers: These are often built into your computer system.  But not always.  Sometimes people use headphones.  Headphones also help keep things quiet and more private.

Reliable internet: We don’t want you to miss anything!

A private space in your home when you take this virtual class:
Confidentiality is important and students want to be able to say things in the class privately.  It is important that others in your home do not accidentally overhear something that someone says confidentially.  We have a saying: “What we share personally in this class, stays in this class.” 

A comfortable place to set up your computer: Set your computer up on a table so that you can sit comfortably in front of it without having to move around.  Good lighting is important.  Just like a class that meets in-person, we want to see your face and we want you to see other people’s faces so you can participate in the class.  

These things will help you have a positive experience in the class and learn much!

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* 14. How do you feel about Connection Class Topic #1?

"Communication - understanding messages we send and receive"

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* 15. How do you feel about Connection Class Topic #2?

"What is public and what is private?"

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* 16. How do you feel about Connection Class Topic #3?

"What is a healthy relationship? What is an unhealthy relationship?"

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* 17. How do you feel about Connection Class Topic #4?

"Gender identity and sexual orientation"

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* 18. How do you feel about Connection Class Topic #5?

"Using social media: internet and phone safety"

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* 19. How do you feel about Connection Class Topic #6?

"Moving from friend to partner (romantic feelings, sexual feelings, dating, intimacy)"

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* 20. How do you feel about Connection Class Topic #7?

Consent. What is yes? What is no? Saying NO.

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* 21. How do you feel about Connection Class Topic #8?

"Exploitation and abuse in relationships"

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* 22. How do you feel about Connection Class Topic #9?

"Understanding our bodies (anatomy, sex, and sexual health)"

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* 23. How do you feel about Connection Class Topic #10?

"Reproduction (birth control, pregnancy, parenthood)"

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* 24. Do you have any other topics you'd like us to address?

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* 25. Is there anything you would like us to be aware of in order to ensure your safety and success in this class? Please describe in the fields below.

If you can't think of any accommodations right now, but something comes up later, just know you can always talk with the instructor for support.

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* 26. Who completed this application?

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* 27. By checking the box below, I authorize Connections class instructors to communicate with my Personal Agent, family, providers or anyone else listed in question #3 regarding this application in order to provide the best possible class experience.

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* 28. Do you have anything else you'd like to share with us?

(Note: You can always change answers from earlier in the application before submitting. Just scroll up and make changes!)

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