QUICC Intro Questions
Welcome! Thank you for your interest in joining Queers United in Community Care.

If there's anything you'd like to say that you don't feel comfortable sharing here, feel free to reach out to one of our members individually.
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Name *
What do you want us to call you?
Pronouns *
Some examples: they/them, she/her, he/him, ze/zir, xe/xem, ey/em, ze/zix, fae/fem, it/its, no pronouns, etc.
Age *
Are you 18 years of age or older?
Branch *
Which location are you applying for?
Race
Optional, we ask this to maintain a group that represents our community
Ethnicity
Optional, we ask this to maintain a group that represents our community
Location (city or town)
Email
Social Media
Some examples: Instagram, Twitter, etc.
Phone
If you don't already have the Signal app installed, you can get it here: https://signal.org/install
Emergency Contact Info
If anything were to happen to you (arrested, in the hospital, etc.), who should be contacted?
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