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* 1. What is the full name you would like to appear on your certificate?

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* 2. Please provide us with the preferred pronunciation of your name.

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* 3. Which of the Claremont Colleges do you attend?

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* 4. Please type your major(s) and minor(s) as you would like them to appear on your certificate.

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* 5. The QRC plans to take photographs at the event with the intent of linking them to lavender graduates and putting a group photo on the QRC website. Do you consent to having photographs of you taken and distributed to fellow lavender graduates as well as being included in a group photo on the QRC website?

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* 6. Please provide us with your contact information (including both email and cell phone). (We will be sending you further information about LavGrad, and post-graduation will send out pictures from the event as well.)

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* 7. Please nominate an LGBTQ faculty member who is an outstanding member of the community and has created a safe and inclusive space for you.

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* 8. Please nominate an LGBTQ staff member who is an outstanding member of the community and has created a safe and inclusive space for you.

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* 9. Please nominate an ally faculty member who through their allyship has created a safe and inclusive space for you and the LGBTQ community.

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* 10. Please nominate an ally staff member who through their allyship has created a safe and inclusive space for you and the LGBTQ community.

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