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2019 CUGALA Participation Survey
Please fill out each section, including your availability for future meetings!
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Pronouns (
https://lgbtqia.ucdavis.edu/educated/pronouns.html
)
*
Your answer
How do you identify your race and/or ethnicity (check all that apply)?
Latinx or Hispanic
White
Asian
Pacific Islander
Black or African American
Native American
Other:
How do you identify your sexual orientation?
Lesbian
Gay
Bisexual+
Asexual
Queer
Questioning
Pansexual
Ally
Intersex
Other:
Clear selection
How do you identify your gender?
Male
Female
Trans* (not cis-gender)
Other:
Clear selection
College and Year (Enter multiple if applicable, separated by a comma.)
*
Your answer
Mobile Phone Number
Your answer
Street Address
Your answer
City
*
Your answer
State
*
Your answer
Zip
Your answer
Other cities you spend significant time in?
Your answer
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