Campus Request Form for Out Youth Services
Out Youth serves Central Texas LGBTQ+ youth and their allies ages 12 - 23 with programs and services to ensure these promising young people develop into happy, healthy, successful adults.

Currently, Out Youth provides on-campus services to LGBTQ+ students in partnership with Communities in Schools of Central Texas as well as other social service or mental health liaisons on campus. During the school year 2018-19, Out Youth will be offering two curricula: Be YOU (Young, Outspoken, Unbreakable), and Tender and Tough: A Healthy Relationships curriculum. Both aim to improve youth wellbeing through weekly group counseling. Out Youth hopes to be able to expand services during the 2019 - 2020 school year, which would include:

- Providing a minimum of 10 psychoeducational support group sessions per campus per semester;

- Providing individual counseling services to 1 – 2 students per campus per semester, based upon need and availability of Out Youth personnel;

- Enhanced technical assistance for starting/maintaining a GSA or similar club on campus; training and professional development for CIS staff and other school personnel regarding gender and sexual diversity.

While we cannot guarantee we will be able to serve all campuses requesting our services, we appreciate you taking the time to complete the following information so we can document your interest.

Please complete the following to indicate your interest in partnering with Out Youth.

Name and title of person completing form:
Your answer
Date:
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Email address:
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Name of Campus:
Your answer
Campus Address:
Your answer
Phone number:
Your answer
Approximate number of students enrolled:
Your answer
Approximate number of students enrolled in CIS:
Your answer
What is the general climate for LGBTQ+ students on your campus?
Does your campus have a GSA (Gay/Straight Alliance, Gender & Sexuality Alliance)?
Does your campus have gender neutral bathrooms?
Are you currently working with other external organizations to provide groups?
Could you arrange for a group to take place at a set day and time each week?
Do you believe teachers and administrators would be supportive of a group from Out Youth?
Approximately how many students do you imagine might be interested in an LGBTQ+ support group?
Your answer
Please describe general procedures, if any, for Out Youth staff to access your campus and to provide a psychoeducational support group (e.g. need to check in with front office, required to bring passes to student classes, etc.):
Your answer
What questions do you have for us about Out Youth services?
Your answer
What would be some good days/times to schedule a phone call and/or meet face-to-face with Out Youth personnel on campus?
Your answer
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