Queens Clinic Escort Interest Survey

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Thank you for your interest! Please fill out this form and we will be back in touch with you by email to let you know of training and volunteer opportunities for clinic escorting.

For any questions, please email queensclinicescort@gmail.com.

Email *

First & Last Name: *

Pronouns *

Phone: *

Why do you want to become a clinic escort? *

What are your beliefs about abortion? *

What, if any, background do you have in reproductive rights? *

Do you speak any languages other than English? If so, what? *

Please provide two references including their name and contact info (phone and/or email). *

Where did you hear about this opportunity? If you heard about us from a current or former escort, please include their info here. *

Follow this link to sign up for a virtual training date: https://signup.com/go/OaGxXhM *

I signed up!

I need a future date/alternate date

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