Silver Rainbow LGBTQ Group of Hampton Roads Survey

Introduction

Welcome to the SIlver Rainbow LGBTQ Club Survey!

Prior to our first meeting on September 29, we want to hear from you! We want to make the most out of our first meeting together and make plans for fun and productive activities that match your interests. We have created a short, anonymous, ten question survey.

If you cannot make it to the September 29 event, we still value your feedback as we look forward to meeting everyone in the 757 interested in our group in the near future.

Thank you for your time. We look forward to meeting you!

Question Title

* 1. Enter your age as of your last birthday

Question Title

* 2. What is your gender identity? (Please mark any/all that apply)

Female

Male

Transgender woman

Transgender man

Transgender

Intersex

Questioning

Agender

Non-Binary

Genderqueer

Genderfluid

Other (please specify)

Question Title

* 3. What is your sexual orientation?

Lesbian or gay woman

Gay man

Bisexual

Pansexual

Queer

Questioning

Demisexual

Asexual

Same Gender loving

Other (please specify)

Question Title

* 4. In what city do you live?

Question Title

* 5. Please enter your five digit zip code

Question Title

* 6. Do you feel you have a support network of at least one person you can go to in the event of an emergency?

Yes

Not sure

Question Title

* 7. If you answered 'yes' to question 6, please identify whom you consider to be part of your personal support network? (Please check any/all that apply)

Spouse/partner

Gay/Lesbian or Bisexual friends

Straight/allied friends

Trans or Gender expansive friends

Family members

Neighbors

Spiritual/Faith leaders

People from church, synagogue, mosque or faith

LGBTQ social clubs/community groups

General social clubs/community groups

Online communities

Other (please specify)

Question Title

* 8. As you age, how important are the following issues? Please rank each issue as it applies to your situation.

	Extremely Important	Very important	Somewhat important	Not very important	Not at all important
Housing	Housing Extremely Important	Housing Very important	Housing Somewhat important	Housing Not very important	Housing Not at all important
Finances	Finances Extremely Important	Finances Very important	Finances Somewhat important	Finances Not very important	Finances Not at all important
Health Care	Health Care Extremely Important	Health Care Very important	Health Care Somewhat important	Health Care Not very important	Health Care Not at all important
Social Isolation	Social Isolation Extremely Important	Social Isolation Very important	Social Isolation Somewhat important	Social Isolation Not very important	Social Isolation Not at all important
Legal Issues	Legal Issues Extremely Important	Legal Issues Very important	Legal Issues Somewhat important	Legal Issues Not very important	Legal Issues Not at all important
Going 'back in the closet'	Going 'back in the closet' Extremely Important	Going 'back in the closet' Very important	Going 'back in the closet' Somewhat important	Going 'back in the closet' Not very important	Going 'back in the closet' Not at all important

Question Title

* 9. What types of activities would like to see the Silver Rainbow group produce? Please select any/all that interest you.

Excursions/group travel

Monthly meeting/social event

Speakers & workshops

Advocacy and training for members of the non-LGBT community

Lobbying public officials

Mentoring

Intergenerational engagement

Development of group housing

Other (please specify)

Question Title

* 10. Would you be interested in getting involved and help plan events and other activities of the Silver Rainbow Group of Hampton Roads?

Yes

If yes, please enter your name and contact information. Thank you!