GSA / School Visit Request Form

GSA / School Visit Request Form
Affirmations Community Center, a partner of the Genders and Sexualities Alliance Network, is excited to offer school and organization visits for youth! Please complete the form below for Affirmations Staff to better understand your wants and needs for us to visit you!

If you have any questions, please contact Joe, Youth Programs Manager at jvolpe@goaffirmations.org.
Requester Information
Name

First NameLast Name
Pronouns
Ex: She/they
Email
example@example.com
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to receive emails regarding Affirmations' youth programming and events?

School / Organization Info
Name of School / Organization
Address of School / Organization

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of group within the organization/school
Can include type of club, sports team, project team, parent group, etc. Example: GSA
How many youth are in your group?
Please note that we require at least 5 youth to do an in-person visit.
What is your role?

Other
Does your advisor or staff member know you are submitting on behalf of the school/organization?
Name of Advisor or Staff Member

First NameLast Name
Advisor or Staff Member Email
example@example.com
Advisor or Staff Member Phone
Please enter a valid phone number.Format: (000) 000-0000.

Background & Request
Describe the general climate of your club/team/group/school.
How did you hear about Affirmations Community Center?
What are type of visit/workshop/presentation are you seeking from Affirmations Community Center staff?

Other
Are you seeking an in-person or virtual visit? (In-person visits are dependent on location)
Please provide general availability or specific dates for a visit. Please provide multiple options.
Ex: Wednesdays in April at 12pm-1pm
How many visits are you requesting?
Each organization/school is limited to 3 visits in one calendar year.
Is there anything else you'd like us to know?
Should be Empty:

Requester Information