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LGBTQ+ SUPPORT PROGRAM
DEMO ENROLLMENT
First Name
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Nickname
Age
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-- Please Select --
13
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15
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18
19
County of Residence
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-- Please Select --
Collin
Dallas
Denton
Kaufman
Rockwall
Other
More counties coming soon!
In order to provide you with the most relevant messages and resources, please indicate which of the following you identify as:
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Lesbian
Gay
Bisexual
Transgender
Questioning
Would rather not say
What type of content, messages and resources would you like to receive?
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Please check all that apply.
Coping/Emotional Support
Social Stigma/Feelings of Isolation
Being Bullied
Feelings of Hopelessness/Helplessness
Dealing with other teenagers
Dealing with my Parents
Dealing with In-School Issues
Terms & Conditions
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I have accepted the Terms & Conditions for this program
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