Friday Night Group Facilitator Application

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If you have any questions about filling out this application, please contact Micah@outrightvt.org. Thanks! Once we receive your application we will contact you to set up a time to talk about your interest in becoming a FNG Facilitator at Outright!

Basics

Preferred First Name: *

Preferred Last Name: *

Date of Birth *

(MM/DD/YYYY)

Preferred Pronouns *

(check all that apply)

She/Her

He/His

They/Them

Ze/Hir

No pronouns

Other:

Required

Gender Identity *

(check all that apply)

Female

Male

Transgender

Gender Liberated

Genderqueer

Two-Spirit

Androgynous

Other:

Required

Sexual Identity *

(check all that apply)

Lesbian

Gay

Bisexual

Queer

Asexual

Pansexual

Other:

Required

Race/Ethnicity *

(check all that apply)

American Indian/Alaska Native

Asian

Black or African American

Hawaiian Native or Pacific Islander

Hispanic/Latino/Latina

White or Caucasian (non-Hispanic)

Other:

Required

Contact

Preferred Contact Method *

(check all that apply)

Phone

Text

Mailing

Required

Street *

Town *

State *

Zip Code *

Phone Number *

Email Address *

Check this box if you would like to be added to our mailing list!

Sign me up!

Where would you be able to facilitate group? *

(check all that apply)

Burlington

Rutland

Montpelier

Brattleboro

Saint Albans

Required

Profession & Skills

Are you... *

(check all that apply)

In School

Employed Full-Time

Employed Part-Time

Unemployed

Required

Occupation *

Place of Employment *

What are some of your hobbies, extracurricular activities, or other interests? *

Questions?

What questions do you have for us?

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This form was created inside of Outright Vermont.