Conversation 360°: Dating & Disability 2021

Conversation 360° RSVP

ONLINE: ZOOM
The Conversation 360° is for individuals who are from a variety of backgrounds to come together in a well rounded discussion about issues in our community that impact the lives of children and adults living with a disability. To help us know who is in the room, please mark the indicator below to which you most closely identify.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Zip Code *
*

I agree to receive electronic information about disABILITYsa updates.
Which session(s) do you plan to attend? *
Hold shift key to select more than one discussion.
In which age category are you? *

12-17 years of age 18 years of age or older
The Dating & Disability discussion is restricted to 18 years of age or older. Since you are between the ages of 12-17 years of age, we will need your parent's permission for your participation. Please provide us with the name, phone, and email address of one of your parents/legal guardians.
Name *

First Name Last Name
Email Address *
example@example.com
How do you identify? (Please select all that apply) *

I am a person with a disability I am a leader in the community I work with leaders in our community I am an employer I am an educator I am a community advocate I am an interested and concerned citizen I care for an individual with a disability I work for a disability service provider (DSP) I am a student in a disability studies program None of the above
Please select the two (2) small discussion topics would you like to join: *

Safety & Dating Romance Meeting Others Inclusion & Diversity Youth & Dating
Preliminary Questions (these questions will be provided to our panelists and discussion facilitators to answer before questions are taken from the floor):
Are you in need of any accommodations for this session?
These next set of questions are optional and help us improve our outreach and funding efforts. Thank you for sharing with us.

There are six questions in this section.
1. Do you identify as any of the following? (check all that apply)

Active Military/Spouse Military Veteran LGBTQ2+ I have autism I live with paralysis I have a disability
Type of disability:
2. What is your age?

Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75+ Prefer not to answer
3. What is your gender?

Female Male Prefer to self-describe Prefer not to answer
Please specify: *
4. What is your race/ethnicity? Check all that apply.

American Indian or Alaska Native Asian or Asian American Black or African American Hispanic or Latinx White or Caucasian Prefer not to answer Native Hawaiian or other Pacific Islander Other
If other, please specify: *
5. Residential Zip Code
6. In what area do you live?

City of San Antonio District 1 City of San Antonio District 2 City of San Antonio District 3 City of San Antonio District 4 City of San Antonio District 5 City of San Antonio District 6 City of San Antonio District 7 City of San Antonio District 8 City of San Antonio District 9 City of San Antonio District 10 Incorporated City other than San Antonio Bexar County Unincorporated
Not sure? Use this link to help you https://www.sanantonio.gov/Council.
Should be Empty:

Conversation 360° RSVP