WT618 CARE Study

- Please answer all the questions to find out if you’re eligible for this research study.
- Your answers are kept confidential and will not be shared with anyone except the research team.
- You may withdraw from this study at any time.
Contact Email
example@example.com
Result*
source

Are you 18 years of age or older?*

YesNo
Do you currently live in the United States?*

YesNo
Do you identify as a sexual minority (e.g., lesbian, gay, bisexual, queer) or are you questioning your sexual identity?*

YesNo

In the past three months, have you experienced violence (e.g., physical violence, sexual assault, threats, or other acts of violence) where you were targeted at least in part due to one or more of your identities (e.g., sexual orientation, race/ethnicity, religion)?*

YesNo
Do you currently have someone (e.g., partner, friend, or family member) who is aware of this violence experience, supports your sexual identity and would be willing to participate in this program with you?*

YesNo

Name*
Email*
example@example.com
Phone number. Please verify it by receiving an SMS/Text message from Wayturn, and enter the code received here.*
Your phone number will only be used by the research team to contact you in case you are eligible to participate.

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