FEJ screening survey

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Email *

Are you a parent/caregiver who identifies as LGBTQ+? *

Yes

Do you identify as BIPOC (Black Indigenous Person of Color)? *

Yes

In your own words please type how you identify including, but not limited to race, gender, gender identity, and sexuality? *

Do you have children of any age? *

Yes

Are you currently seeking to create or expand your family? *

Yes

Maybe

If you have children, how many and how old are they? *

Do you live in an urban, suburban, or rural community? *

Urban (city)

Sububurban (outside of the city, but close)

Rural (country)

What region of the United States do you live in? *

Northeast

South

Midwest

West Coast

Puerto Rico, Hawaii, Alaska, or other U.S. territory

Pacific Northwest

Southwest

Other

Please provide your name, contact information, best method of reaching you, and best time of the day to have a short conversation. *

Send me a copy of my responses.

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