LGBTQ Online Assessment

Please complete this short questionnaire to assist us in better understanding your individual and programmatic needs regarding Sexual and Intimate Partner Violence among the Native Lesbian, Gay, Bisexual, Transgender, and Two-Spirit (LGBT2S) community.

What Organization do you represent?

Tribal ProgramCommunity Based OrganizationDomestic Violence ShelterTribal Law EnforcementOther Law EnforcementTribal CourtIndian Health ServiceOther Tribal-Health ServiceEducational InstitutionTribal CoalitionLGBT OrganizationCommunity Member

What is your current position?

Program Director/ManagerProgram ManagerSupervisorAdvocateCounselorOutreach Coordinator/WorkerVolunteerCommunity MemberOther

What kind of LGBT2S victimization are you seeing in your community? (Check all that apply)

HateIntimate Partner ViolenceTraffickingBullyingSexual AssaultMurderOther

In regards to Hate crimes, what have been the motivation indicators? (Check all that apply)

Anti-LGBQ/Homophobia/BiphobiaAnti-Sex workerAnti-Transgender/TransphobiaHIV/AIDS-relatedRacist/anti-ethnicSexistOther:

Please list all LGBT2S services provided in your area:

I am not aware of any LGBT2S services in my area.

Education and Training Needs (Check all that apply)

LGB2S 101Transgender 101LGBT2S SensitivityLGBT2S DV/IPV StatisticsHIV/AIDS 101HIV/AIDS & DV/IPVOther:

Technical Assistance & Capacity Building Needs (Check all that apply)

Program Policy and Procedures DevelopmentLGBT2S-specific Shelter Policy DevelopmentStaff Sensitivity Training Curriculum DevelopmentLaw Enforcement ResponseLGBT2S-inclusive Screening & Assessment Tools DevelopmentCultural Appropriate LGBT2S DV/IPV Resource Materials DevelopmentHIV/AIDS Program & Shelter Policy DevelopmentHIV/AIDS Screening & Assessment Tools DevelopmentUniversal Precautions Policy DevelopmentLinkage to HIV Services Protocol DevelopmentOther

THANK YOU!

Providing your name, organization, email is optional

Date:

FIRST NAME:

LAST NAME;

Title/Position:

Organization:

Department:

Tribal Affiliation:

Email:

This form will be sent to our program specialist, Kurt Begaye who facilitates all LGBT2S programmatic information.

SWIWC's LGBTQ Training & Technical Assistance Questionnaire

Information below is optional

Verification

SWIWC