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June 2021 Power Up Registration
Thank you for registering for the Power Up! Queer and Trans Workers' Rights Workshop by LGBTQ Allyship. We appreciate your time and want to be sure we are providing all the resources and advocacy for you. This form helps us secure our grant funding for this work. Again, thank you.
If you are Unemployed, a Gig Worker, or work in the Retail or Service industry please take the time to fill out the extra questions. We are collecting information to better support the unemployed, gig, retail, and service workers. Thank you for being part of the moment.
Contact Information
Name
*
First Name
Last Name
What pronouns do you use?
*
E.g. she/her, they/them, ze/zir, he/him
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Phone
*
LGBTQ Questions
LGBTQ Allyship would like to ask a few questions to help support our community, this allows us to see where support is needed. Thank you for taking a few minutes to answer some demographic questions.
Age
*
Under 18
18-24
25-34
35-44
45-54
55-64
64+
How do you describe your gender identity?
*
Check all the apply
Transgender
Two Spirit
Cisgender
Agender
Gender fluid
Genderqueer
Gender non-conforming
Gender variant
Man
Woman
Androgynous
Femme
Butch
Other
Other
How do you describe your race and ethnicity?
*
Check all that apply
Asian
South Asian
American Indian or Alaskan Native
Black or African American
African
Middle Eastern or Arab
Latino/a/x
Multiracial
Native Hawaiian or Pacific Islander
White
Other
Other
Do you need an interpreter?
*
Yes
No
If yes, what langauge?
How do you describe your sexual orientation?
*
Queer
Bisexual
Lesbian
Pansexual
Fluid
Asexual
Gay
Heterosexual
Other
Other
What industry do you work in?
*
Even if you are not working at this time what industry do you work in.
How did you hear about this event?
LGBTQ Allyship FaceBook
FaceBook Group (please provide name of group)
Instagram
LGBTQ Allyship's Website
LGBTQ Allyship's Newletter
Other
Other/Name of Group
Are you interested in fighting for queer and trans economic and housing justice with LGBTQ Allyship?
Yes, I'm in!
No thank you, but thanks for doing this work!
I'm not sure, can I get some more information?
Please Respond to the Questions below if you are UNEMPLOYED/GIG WORKER/RETAIL OR SERVICE. If they do not pertain to you please skip.
UNEMPLOYMENT QUESTIONS
What profession/job did you get laid off from?
What is your current situation with unemployment?
Currently receiving benefits
Still waiting for benefits
No longer unemployed, but I received benefits in the last year
No longer unemployed, still have not received the benefits I was owed
I have not filed for unemployment in the last year
Other
What issues have you been dealing with now and in the last year with unemployment?
Please check all that apply
Long wait for payment after applying
ESD stopped payments
Got an overpayment notice
Received collections letter
Denied incorrectly
Still not received $ after ESD stopped payments
Still have an active over payment notice
Still in collections currently
Other
Have you had barriers of applying for unemployment?
If yes, what were/are they?
GIG WORKERS QUESTIONS
What kind of Gig Work do you do?
Food Delivery
Ride -Share
How long have you been working your current job?
less than 6 months
6 months to a year
1 year
2 years
more than 2 years
Have you been informed about the Paid Sick and Safe Time by your employer?
Yes
No
Do you feel your safety is compromised when working as a gig worker?
Yes
No
If so in what ways, please give examples.
Have you been supported by your employer when it comes to COVID-19 and your safety?
Yes
No
If yes, in what ways? Please explain.
Have you been informed by your employer about Hazard Pay in Seattle?
Yes
No
After the hazard pay was issued, have your hours or pickup or drop off areas significantly changed?
Yes
No
Do you receive a paystub that informs you of your hazard pay earned and other pay?
Yes
No
RETAIL AND SERVICE
What type of job do you work in now?
Restaurant
Retail
Grocer
Mechanics
Sales
Other
Does your work have plans set in place for COVID-19 safety?
If yes, what are they?
Are you receiving your paid breaks during your work hours?
Yes
No
Have your hours been cut due to Covid-19?
If so, how much?
If your hours have been cut due to COVID-19 have you been informed about how to apply for unemployment for reduced work hours?
Yes
NO
Are there other issues that you are addressing that have not been asked around pay, safety, hours?
Please provide your response here.
Thank you for registering and taking the time to help by answering the questions!