Saathi - Desi Rainbow Peer Support Recipients

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The information you provide here, including contact information, time available, language spoken is requested so that we can match you with a peer supporter who shares your experience as much as possible.

Email *

Name *

Pronouns (what you would like us to use when we refer to you. Eg. she/her, he/him, they/them) *

Briefly tell us the reason you are seeking support so we can match you with an appropriate supporter *

I am (check all that apply) *

Parent of an LGBTQ child/adult

A family member of an LGBTQ child/adult

An LGBTQ identified person

Questioning

Other:

Required

My national origin and religious background

My zip code *

Phone number *

Time Zone (Eastern, Central, Mountain, Pacific) *

Days of the week that you would like to receive a call *

Time during day when you are available *

What is your preferred language for this call? We cannot guarantee that we can provide support in your preferred language, but will do our best!

Would you like to receive our monthly newsletter? It will be emailed to the email you have provided. You can also sign up for the newsletter on our website *

Yes

No, not at this time

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