LBR Interest Form
Every day, young people navigate relationships - crushes, breakups, sexuality, firsts, and hookups - but they don’t always have the space to talk about them, learn about them, or share their experiences and educate others. Let’s Be Real creates that space. Grounded in our belief that everyone deserves a healthy relationship and everyone can take action in their own way, we amplify the voices of young people ages 12-24.
Let's Be Real provides you with online and in-person opportunities to have real conversations about your experiences, tap into your creativity, and apply your individual gifts and talents towards building a culture without abuse. Please fill out this form so that we can get to know you as well as to connect you to resources, events, and opportunities.
Follow us:
Instagram- @breakthecycle
Twitter- @breakthecycleDV
*Responses are used to best match young people with projects and their information is not shared beyond BTC staff*
* Required
Email address
*
Your email
Full Name:
*
Your answer
Pronouns:
Your answer
How did you hear about us?
Your answer
How would you describe yourself? (Some projects are looking for specific populations, ex: an LGBTQ group may be looking for a nonbinary speaker for their conference)
Gay
Lesbian
Same-gender loving
Bisexual
Queer
Asexual
Pansexual
Questioning
Heterosexual or Straight
Nonbinary
Prefer not to say
Do you identify as transgender?
Yes
No
Prefer not to say
Clear selection
I identify my ethnicity as.. (This will help us inform our work and better serve our communities)
Asian
Black/African
Caucasian
Hispanic
Native American
Pacific Islander
Prefer not to answer
Date of Birth:
*
MM
/
DD
/
YYYY
LBR is a space for students 12-24. Please tell us your age:
*
Choose
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Location: (City, State)
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Your answer
Phone number:
Your answer
Best days/ times to contact you?
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Your answer
Can we follow up with you? If so, what is the best way to contact you? (check all that apply)
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email
text
phone call
instagram
Google hangout
Zoom
please don't contact me. I'd like to follow along on my own via social media.
Required
Instagram handle:
Your answer
Most used Social Media Platform: (Pick one, we want to learn what platforms young people are using the most at the moment)
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Instagram
Twitter
Snapchat
Youtube
Tumblr
TikTok
Spotify
Other:
Topics that interest you:
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In Person Peer-Education / Training & Educating peers
Social Media & Digital Educators
Policy & Legislative Advocacy
Adult Education (Technical Assistance) / Training & Educating Adults
Outreach & Awareness Campaigns (such as Teen DV Month & Sexual Assault Awareness Month)
Speakers / Youth Survivor Speakers Beaurau
Fundraising
Tool & Resource Development
Social Media Content Creators (Social Media posts, blog, website, etc.)
Digital Art
Other Ideas:
Your answer
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