Youth Facilitated Stakeholder Dialogue

Sexual Health Forum For Youth
WV FREE is inviting West Virginia youth (ages 14-24) to join us for a virtual dialogue and educational session that will focus on sexual health.

Sexual Health is defined as "a state of physical, emotional, mental and social well-being in relation to sexuality." Sexual health is important for everyone, not just people who are having or thinking about having sex. During this session, we will have an honest, open, judgement-free conversation about what sexual health means to you, what you have heard about it from friends, family, or in the media, and what factors influence the sexual health of young people like you. During the forum, you will be asked about your reactions to, or knowledge of, specific sexual health information. You will not be expected to share personal health information if you do not want to. Any information that is shared will be anonymously documented and not associated with identifying information in any way.

Information and feedback collected during this forum will be used to improve WV FREE's sex education programs for young people, and to help us understand how best to reach youth with this vital information. All participants in the forum will receive a $30 gift card as compensation, as well as access to a variety of free sexual health resources and materials. You are also eligibile to recieve additional compensation for refferals.

Eligibility Requirements - In order to participate, you must:
- Be between the ages of 14 and 24
- Be a current resident of West Virginia (individuals attending school or on a temporary work assignment out of state, but whose permanent address is in WV, may also attend)
- Have access to a computer, tablet or smartphone with reliable internet access and videocall capabilities for the duration of the session
- Be able to attend for the entire session
Gift cards will be distributed after the forum is over, and only to those who are in attendance for the full length of the session.
Pronouns*
Example: he/him, she/her, they/them
Name*
What name would you like us to call you?
Email address*
Please double check the spelling of your email address as this is how we will send you the Zoom link for the session!
Your county*
Tip: If you aren't sure what county you live in, you can type in your address at https://gps-coordinates.org/what-county-am-i-in.php and find out! You must be a current resident of West Virginia to participate.
Age*
You must be between the ages of 14 and 24 on the date of the dialogue session to attend.
In order to confirm your eligibility, please upload a photo of a current student ID, driver's license or other ID card. WV FREE will not share this data with anyone and will delete this photo as soon as verification is completed.*

If you are unable to upload a photo or do not have an identifying document, please email our SHARE Program Coordinator Kelsey at kelsey@wvfree.org, for alternative instructions on how to complete this form.
Cancelof
Which session are you interested in attending?*

October 24th, 5:30 - 7:00PM/ESTDecember 12th, 6:00 - 7:30PM/EST
Gift Card Preference: Participants who attend the full length of the dialogue session will receive a $30 e-gift card after the session is over. Please select your gift card preference below,*

AmazonBookshop.orgWalmart
Would you like to receive a resources package from WV FREE? This contains materials such as condoms, dental dams and information about sexual health. This is free to you, and completely optional.*

Yes!No Thanks
Would you like to receive a resources package from WV FREE? This contains materials such as condoms, dental dams and information about sexual health. This is free to you, and completely optional.*
If yes, please provide a full mailing address. We are not able to ship to addresses outside of West Virginia.
We will ship the Safer Sex Resource package after your attendance of the session.
If you require any accommodations (e.g. live captioning) to fully and comfortably participate in the dialogue session, please share them here.
Members of our SHARE team are mandated reporters under the West Virginia state child welfare policy. This means that what you say during the workshop is confidential with our team, except in cases where abuse or neglect of a minor child (person under 18) is suspected or disclosed. If child abuse and/or neglect is suspected or disclosed, staff are required by law to notify Child Protective Services within 24 hours. Please check the box below to indicate that you have been made aware of this policy. Note: Participation in all workshop activities is voluntary -- participants will never be forced to share information about themselves they do not wish to disclose.*

I understand that SHARE facilitators are mandated reporters under WV state lawI do not understand and would like more information on mandated reporting before I participate
How did you hear about this event?*

FriendTeacher, counselor or coachParent, guardian or other family memberWV FREE staff memberInstagramFacebookStudent organization or clubWV FREE e-blastWV FREE websiteTabling eventYAC MemberOther
Name of the YAC Member who referred you:
What are you hoping to learn from this workshop?*
Demographics

For grant purposes, we are collecting the demographic data of our participants. Your demographic information will not be connected to your name in any way; if you do not wish to answer, please select "I prefer not to say." The provided answers may not reflect your identity, you may specify your answer in questions that provide an "other" selection.
What is your racial identity?

American Indian or Alaskan NativeAsianBlack or African AmericanMiddle EasternNative Hawaiian or other Pacific IslanderWhiteMore than one raceI prefer not to say
Do you identify as Hispanic or Latinx?*

YesNoI prefer not to say
What grade or type of education do you currently attend?*

6th or less7th8th9th10th11th12thGED ProgramTechnical/Vocational TrainingCollege/UniversityUngraded (school without formal grade levels)Not currently in school; highest degree: high school/GEDNot currently in school; highest degree: college/university/technical/vocational trainingNot currently in school; no degree obtainedI prefer not to say
Which of the following best describes your gender identity?*

MaleFemaleNon-binaryI prefer not to say
Which of the following best describes your assigned sex at birth?*

MaleFemaleIntersexI prefer not to say
Which of the following best describes you?*

CisTransI prefer not to say
Which of the following best describes your sexual orientation?*

AsexualBisexualLesbian, gay or homosexualQueerQuestioningStraight or heterosexualI prefer not to say
Please verify that you are human*
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Sexual Health Forum For Youth

Demographics