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GSA Site Visit Request Form
*
Indicates required field
What is the name of your school?
*
School Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name(s) of person(s) filling out this form, titles/positions, and contact info:
*
i.e. Latreece Whitfield, GSA Network Coordinator, Latreece@kycohio.org, (614) 294-5437
What is your preferred site visit date and time?
*
i.e. 12/12/13 at 2:00-3:00pm
If we can't do a site visit on your preferred date and time, what is your secondary choice for date and time?
*
i.e. 12/12/13 at 2:00-3:00pm
Where does your GSA meet?
*
Provide parking information for your school
*
Current advisor(s) and years served:
*
On average, how many students typically come to your GSA meetings?
*
Does your GSA have elected officers?
*
Yes
No
Unsure
Does your GSA have a mission statement?
*
Yes
No
Unsure
Does your GSA have a constitution?
*
Yes
No
Unsure
Which of the following activities applies to your GSA (Check all that apply)
*
Support/discussion group
Social gatherings and hanging out
Campus education, activism, and campaigns
Does your GSA organize with other student groups on campus?
*
Yes
No
Unsure
GSA Activities, Events, and Campaigns
Has your GSA organized any of the following Days of Action or events in the past year? (Check all that apply)
*
Day of Silence
Transgender Day of Remembrance
National Coming Out Day
LGBTQ History Month
LGBTQ Black History Month
Held 1 or more fundraisers
Delivered peer education workshops (workshops for your classmates)
Delivered teacher education workshops (workshops for your teachers)
Conducted a school climate survey (about homophobia and transphobia in your school)
Ally Week
No Name Calling Week
GSA Day
Spirit Day
None
Other
If "Other" please list
*
In what ways could KYC Connect help you most?
*
Submit
Who We Are
Contact Us
Meet the Team
>
Board of Directors
Join the Team
How to Find Us
Celebrating 25
What We Do
Programs
>
Genderscope
>
GAP
David Bohnett Cyber Center
Accessibility
Education and Training
>
Ohio GSA Network
Housing
>
Rapid Rehousing
Host Home Network
Supportive Cohousing
Resources
Speaking Queerly
Get Involved
As a Youth
As a Guardian
As a Community
As a Volunteer
>
Volunteer Sign-Up
Calendar
Give Now
Wish List
