Expression of Interest - LGBTQIASB+ Peer Education Workshops
Thank you for your interest in helping us design our workshops! This is just a quick survey to let us know a little bit about you. For more information on what's involved please read or download the pdf below:
About You
What is your name? (Preferred)
*
First Name
Last Name
What are your pronouns? (i.e. she/her, he/him, they/them etc.)
I am:
*
A LGBTQIASB+ person aged 16-25
An ally aged 16-25
A caregiver of a LGBTQIASB+ young person
An educator/member of school staff
A service provider working with young people
Other
I am my child's:
Mother
Father
Grandparent
Guardian
Other family member
Other
How old are you?
What is your profession?
What is your postcode?
Culture
Do you identify as Aboriginal and/or Torres Strait Islander?
Yes
No
Not sure
Prefer not to say
What is your cultural background?
Do you speak a language other than English at home? If yes, please describe:
Gender and Sexuality
How do you describe your gender identity? (i.e. woman, man, non-binary etc.)
How do you describe your sexual and/or romantic orientation?
Neurodivergence, Difference, and Disability
Are you neurodivergent? If so, please describe:
Do you have a disability and/or chronic physical/mental health condition? If so, please describe:
Participating in this Project
I would be interested in taking part by (please tick all that apply):
One-on-one interview in-person (headspace Midland)
One-on-one interview online
Completing a survey
Taking part in a focus group
Other
Do you require any accommodations or adjustments to take part? If so, please describe:
How confident are you in supporting LGBTQIASB+ young people?
Not at all confident
Slightly confident
Somewhat confident
Fairly confident
Completely confident
Consent
I consent to being contacted via email about this project:
*
Yes
No
Please provide an email you are comfortable being contacted at:
example@example.com
Submit
Should be Empty: