Queer Scholars' Program Intake
We appreciate you self-identifying and letting us know what services you need. As a new program, we need to document that there is a need for LGBTQIA+ services. Thank you!
Affirmed Name
Legal Name
Pronouns
Common pronouns: She/He/They/Ze
Student ID
9 digit student ID
I identity as:
example: Pansexual and Transgender
Student E-mail
Phone Number
Cell Number where you can receive reminders
Support and Services Needed:
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Academic Counseling (ex: Ed Plan/Transfer)
Academic Support (ex: tutoring)
Career Exploration
Gender Identity Support
Sexual Identity Support
Food Insecurity
Psychological Support
Group Therapy
Social Events
Weekly Student Meetings
Printing Services
Food Vouchers
Textbook Voucher
Community Resources
Health Access
Sexual Health Access
Submit
Should be Empty: