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Queens Clinic Escort Interest Survey
Thank you for your interest! After you fill out this form, you should receive a confirmation email with a link for you to sign up for a training.
For any questions, please email
queensclinicescort@gmail.com
.
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Email
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Your email
Full Name:
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Your answer
Pronouns:
*
Your answer
Phone:
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Your answer
Why do you want to become a clinic escort?
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Your answer
What are your beliefs about abortion?
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Your answer
What, if any, background do you have in reproductive rights?
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Your answer
Do you speak any languages other than English? If so, what?
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Your answer
How did you find out about us?
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Your answer
Please provide two references including their name and contact info (phone and/or email). If you know a current or former escort, include them here.
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Your answer
We host monthly Zoom trainings on weekday evenings. Once we have reviewed your application, we'll send you scheduling information and Zoom links. If you haven't heard from us in more than a month, please email us at
queensclinicescort@gmail.com
. We appreciate your patience!
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