Resource Guide Agreement (Web Integrated)

Resource Guide Agreement
Affirmations Community Center connects the LGBTQ+ community with safe, affirming services. This survey helps your organization assess its commitment to inclusion and racial equity and gathers info for our online LGBTQ+ Resource Guide.

What’s in it for me?
Our guide reaches thousands annually through programs like food pantries, testing clinics, youth gatherings, and support groups. Many seek resources where they know they’ll be treated fairly. Listing your services here increases your visibility and trust within the LGBTQ+ community.

What’s expected of me?
We ask for up-to-date service info and confirmation that your policies align with current standards of LGBTQ+ affirming care. Our goal is to ensure community members can access your services free from discrimination. We welcome feedback from users to protect the community and help your organization grow. If concerns arise, we’ll open a dialogue and offer support or training as needed. If your organization isn’t open to this, this guide may not be a good fit.

Thank you for helping us enhance access to vital, affirming resources!
Name of Organization*
In your own words, describe your group and/or the services you offer (in 300 characters or less):*

This will be exactly how it will appear on our website. We may update it as needed for the sake of length, flow or clarity.0/300
Primary Contact *
The person Affirmations would reach out to if there is significant feedback from the community
Primary Contact Pronouns*
The person Affirmations would reach out to if there is significant feedback from the community
Primary Contact Phone Number*
Please enter a valid phone number that Affirmations would reach out to if there is significant feedback from the community
Primary Contact Email Address:*
Please enter a valid email that Affirmations would reach out to if there is significant feedback from the community
Community Contact Phone Number*
Please enter a valid phone number that the community would use to contact you and your service.
Community Contact Email Address:*
Please enter a valid email that the community would use to contact you and your service.
Physical Address*
Website*
Are your services limited by geographical location in anyway? If so, what regions do you serve?
Hours of Operation*
Please select at least one, and up to four, resource categories that best describe your organization and services:*

LGBTQ+ Friendly Businesses & ServicesCommunity & ConnectionCommunity CentersSports LeaguesMultilingual ResourcesTrans & Non-Binary ResourcesLGBTQ+ Job AccessSocial Services for AgingLGBTQ+ Youth ResourcesParenting ResourcesPersonal Care ResourcesHolistic HealthSexual & Reproductive HealthMedical Providers & ClinicsMental Health ServicesRecovery ResourcesLegal ServicesName & Gender Marker Change ResourcesHousing Advocacy & Support OrganizationsEmergency Housing & SheltersFood Access ServicesClothing ClosetsAffirming Faith & SpiritualityOther
If you chose "other" please describe
If you're seasonal or temporary, please explain the scope and limitations to your service(s)
If you are a healthcare provider, what insurances do you accept at this time?
Final Agreements
Do you agree to maintaining communication with Affirmations and as well as maintaining a commitment to addressing internal barriers to services delivered to our community that upholds dignity and respect for all persons?*

YesNo
Do you agree to remaining open to receiving feedback from a member of the Affirmations LGBTQ+ Community Center Staff team if/when there is an incident of negative feedback, specifically in the realm of discriminatory practices reported?*

YesNo
Name and Job Title of the person who completed this form*
Should be Empty:

Resource Guide Agreement

Final Agreements