Census Engagement Form

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Hi! Thanks for signing up to participate in our efforts to make sure LGBTQ+ Houston is represented accurately and comprehensively on the 2020 U.S. Census. While there won't be any questions about sexuality on the Census, we want to make sure that our community is represented as fully as possible. More representation in this once-a-decade data mining project means the potential for more federal funding to those in our community with the greatest needs!

This Census Engagement Form serves two purposes. The first is to get the contact information for our community members and stay in contact with them throughout the census timeline about specific events we're planning to educate and empower individuals to complete the Census. In addition, and of more importance, this serves as an example of just how easy it could be for the form to allow individuals to self-identify along the gender and sexuality spectra. With these simple additions, we would have a better sense of the breadth and scope of our community. A redacted version of this data could also serve as a representative sample for future actions regarding the Census so that, by the 2030 Census, many of our current concerns will be non-issues!

With that, please fill out the form below and help us....

First Name *

Last Name *

Street Address

City *

State *

Zip

Email (Optional)

Preferred Phone (Optional)

Gender Identity (Check any that apply) *

Female

Male

Cisgender Female

Cisgender Male

Transgender female/feminine

Transgender male/masculine

Transgender Non-binary

Intersex

Agender

Genderqueer/Gender Non-Conforming

Pangender

Don't Know

Other:

Required

Pronouns (Check any that apply)

She/Her/Hers

He/Him/His

Ze/Hir/Zirs/Hirs

They/Them/Theirs

Just Use My Name

Sexuality/Orientation (Check any that apply) *

Asexual

Bisexual

Gay

Gay/Lesbian

Heterosexual/Straight

Lesbian

Pansexual

Queer

Questioning

Don't Know

Other:

Required

Ethnicity: Are you of Spanish/Latinx origin? (Optional - for Statistical Info Only)

Yes

Decline to Answer

Clear selection

If yes to the above, which of the following best describes you?

Mexican, Mexican American, Chicano/a

Cuban

Puerto Rican

Other/Multi-Hispanic, Latinx, or Spanish Origin

Decline to Answer

Clear selection

Race (Optional - for Statistical Info Only)

American Indian or Alaska Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White

Other:

Clear selection

Communities that don’t get fully counted in 2020 will miss out on valuable funding and resources for the next decade. Now is the time for Houston’s LGBTQ community to get involved. The Census counts. So do you! Will you take the pledge?

I pledge to be counted and to educate my community about the importance of participating in the 2020 Census.

Submit

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