Keele Community Hub Listening Sessions Registration Form: Open Sessions

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Thank you for your interest in the Listening Sessions hosted by the University of Toronto in partnership with the Keele Community Hub.

We have reached capacity for the Open Sessions. If you fill out this registration form, we will add you to the waitlist and notify you if spaces open up.

Email *

Pronouns

Email Address *

Gender:

Woman

Man

Trans woman

Trans man

Gender non-binary (including gender fluid, genderqueer, androgynous)

Two-Spirit

I don't know

I choose not to answer

Other:

Clear selection

I self-identify with one of the following sexual orientations:

Gay

Lesbian

Straight/Heterosexual

Bisexual

Queer

Two-Spirit

Pansexual

Asexual

Questioning

Another identity or term

I don't know

I choose not to answer

Clear selection

Do you identify as a person with Disabilities?

Yes

I don't know

I prefer not to answer

Clear selection

If yes, please indicate the kind of disability:

Blindness or low vision (does not include vision correctable by glasses or contact lenses)

Deaf, deafened or hard or hearing

Developmental or cognitive disability (example: Down syndrome)

Learning disability (example: dyslexia)

Mental health disability (examples: addictions, bipolar disorder, depression)

Mobility disability (examples: cane, wheelchair)

Physical, coordination, manual dexterity, or strength (example: handling objects)

Physical illness and/or pain (examples: diabetes, epilepsy, heart condition, kidney disease, lung disease, rheumatoid arthritis)

Speech and language disability (not caused by hearing loss)

Other:

Clear selection

How would you describe your race/ethnicity? If more than one, please select all that apply.

Arab, Middle Eastern or West Asian (examples: Afghan, Armenian, Iranian, Lebanese, Persian, Turkish)

Black (examples: African, African-Canadian, or Afro-Caribbean)

East Asian (examples: Chinese, Japanese, Korean)

First Nations (status, non-status, treaty or non-treaty), Inuit or Métis,

Latin American (examples: Brazilian, Colombian, Cuban, Mexican, Peruvian)

South Asian or Indo-Caribbean (examples: Indian, Indo-Guyanese, IndoTrinidadian, Pakistani, Sri Lankan)

Southeast Asian (examples: Filipino, Malaysian, Singaporean, Thai, Vietnamese)

White (examples: English, Greek, Italian, Portuguese, Russian, Slovakian)

I prefer not to answer

Other:

Age

Under 15 years

15- 20 years

20-25 years

25 - 34 years

35 - 44 years

45 - 54 years

55 - 64 years

65 -74 years

75 - 84 years

85 years or over

Prefer not to say

Clear selection

City

What do you do for a living? (i.e. what is your job or occupation, including taking care of the family)

Program of Study (if applicable)

Institution of Study (if applicable)

Please tell us how you typically get to your institution

"I commute to my institution in a car I own."

"I commute to my institution in a shared ride."

"I commute to my institution in my family car."

"I take the bus to my institution."

"I walk to my institution."

"I use the subway to get to my institution."

"I bike to my institution."

Not applicable

Other:

Clear selection

Pick one of the options that best describes your neighborhood based on how marginalized it is:

“My neighbourhood is not left out or ignored.”

“I would describe my neighbourhood as having a lower level of being left out or ignored.”

“My neighbourhood has a middle level of being left out or ignored.”

“My neighbourhood seems to have a high level of being left out or ignored.”

Other:

Clear selection

Do you rent or own your home?

Rent

Own

Clear selection

How many families currently live in your home?

One family

Two families

Three or more families

Clear selection

Which listening session would you like to attend?

Tuesday August 5, 2025 at 1-3pm

Thursday August 7, 2025 at 4-6pm

Submit

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