Acadiana Queer Collective Resource Participant Application Form
If you are interested in being listed on Acadiana Queer Collective's (AQC) Resource List please take a moment to fill out the questions below. Once received, the application will be considered by AQC through out vetting process. Please note that a reference email MUST be included for consideration. We do not have the resources to call references at this time. 

We process applications once per month. If your name is still not listed after this time period please reach out to Health@acadianaqueercollective.org so that we can troubleshoot together.
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Email *
What is the name of your company/agency? *
What is your name or the name of the representative of your agency/company? *
If approved, what contact information would you like listed on the resource page? *
What credentials do you or members of your organization hold (if any)? (E.g., Dr., CAC, LPC, LCSW, etc) Don't worry if you don't have any--just simply respond, "N/A" :)  *
Have you had any complaints lodged against you, your agency/company? If so, please explain below.  *
Can you please provide AQC with a reference that can vouch for you, your agency/company? This person should be able to speak to your work with the LGBT community. (Please include an email address. If this is not included the application will be rejected.) *
Are you or any members of your organization/company a member of the LGBT community? *
What type of services do you provide? *
Required
If you selected the option, 'Other' above can you please share a brief description of the services you provide?
What sort of training have you participated in that allows you to positively serve the LGBT community effectively? (E.G., Safe Space Training, HRC Equality Action Academy Training Sessions, Continuing Education - Specific Topics Listed, etc) **Please be as specific as possible--we need more than 'Continuing Education'**

Don't have any trainings in your profession? That's okay--just let us know below :) 
 *
Why is it important to you to be listed on the Acadiana Queer Collective Resource list? *
If approved to be listed on AQC's Resource list do you agree to have your information shared at various AQC related events? (E.g., Pride Acadiana, Family Fun Days, etc) *
How did you hear about AQC? *
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