Cypress College LGBTQ+ Student Interest Form
Thank you for your interest in LGBTQ+ resources, support, and community at Cypress College. We look forward to connecting with, learning from, and serving you.

The information you provide here will only be used by the campus LGBTQ+ Liaison, the Office of Institutional Research, and the Campus Communications Office (to send private emails to you). Your information will not be shared in any way that will out you. It will be used to better serve you.

If you have any questions or concerns before submitting this form, please contact the campus LGBTQ+ Liaison, Jenelle Herman, at
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Banner ID (8-digit Student ID Number)
Last Name
Chosen First Name  (If this is different from your legal name, you can update Canvas, faculty rosters, and your student ID card to reflect your chosen name if you would like. Go to for more information.)
Pronouns (check all that apply)
Preferred Email Address. (Please provide an email address where you feel comfortable receiving LGBTQ+-related information. This may be your campus email address or another personal email address.)
Please add me to the Cypress College LGBTQ+ Collaborative Canvas page. 
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I'm interested in participating in...
The following information is optional.
Your responses will be kept private and secure. This information will only be used to provide more specific LGBTQ+ resources and information to you and to ensure that our campus LGBTQ+ data is as accurate as possible so that we can provide better support and services for all of our LGBTQ+ students. The information will never be made public and will never be used to discriminate against you.Only the LGBTQ+ Liaison and Institutional Research will have access to this information.You can change this information at any time by resubmitting this form.
Sexual Orientation (optional; choose all that apply):
Gender Identity (optional; choose all that apply):
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