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EVENT - Training/Consultation Request
Help us become LGBTQ+ friendly!
Contact Information
Name
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First Name
Last Name
Pronouns
Please check all that apply.
he/him/his
she/her/hers
they/them/theirs
Other pronouns I use:
Email
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Phone
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Address Type
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Home
Work
Address
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Address Line 1
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City
City
State
State/Province
ZIP/Postal Code
Employer Info
Organization Name
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County you/your employer serves
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** I don't work in Maine **
Statewide
Androscoggin
Aroostook
Cumberland
Franklin
Hancock
Kennebec
Knox
Lincoln
Oxford
Penobscot
Piscataquis
Sagadahoc
Somerset
Waldo
Washington
York
Type of organization.
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Behavioral Health
Business
County
Crisis Provider
Education
Faith Based
Federal
Foster Care
Health and Wellness
Juvenile Justice
Legal
Medical
Mental Health
Municipal
Nonprofit
Other Provider
Public Health
State
Student
Tribal Government
Youth Organization
Youth Organization - Camp
Job title?
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Administrator
Admissions
Art Teacher
Artist
Assistant Superintendent
Attorney
Behavioral Health Professional
Case Manager
Child Protective
Clergy
Coach
Counselor
Curriculum Coordinator
Disability Services
Ed Tech
Executive/Director/President/CEO/Owner
Guardian ad litem
Health and Wellness Professional
Health Teacher
Law Enforcement
Librarian
Mental Health Provider
Nurse
Nurse Practitioner
Osteopath
Physician
Physician's Assistant
Press
Prevention Provider
Representative/Legislative
Resource Officer
Retired
School Board
Social Worker
Staff
Superintendent
Teacher
Does your school have a GSA/GSTA or Civil Rights Team?
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Yes
No
Unknown
Are you a GSA/GSTA or Civil Rights Team Advisor?
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GSA/GSTA
Civil Rights Team Advisor
Neither
School Info
School District
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Type of School
Select "District" if you work at the district-level.
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4H/Extension
College
Community
District
Elementary
High School
K-12
K-8
Middle School
Pre-K
Preschool
School
Tech/Voc
Consultation & Training Requests
Consultation or Training?
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I would like to schedule a short consultation with someone from your organization to discuss training options for me or my team.
I would like to schedule a short consultation to discuss a topic other than training.
I would like to schedule a training with OUT Maine.
Have you, or your organization, received training from OUT Maine in the past?
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We have not received any training from OUT Maine.
We received an introductory training from OUT Maine more than 2 years ago.
We received an introductory training from OUT Maine less than 2 years ago and would like a refresher for new staff or current employees.
We received an introductory training from OUT Maine less than 2 years ago and are looking for advanced training to strengthen our knowledge base.
We received training on this topic from an organization other than OUT Maine.
Other, not listed above.
Other-Training
Please describe any training you have received in the past on LGBTQ+ youth topics and with what agency.
Would you prefer for your training to be presented via Zoom or in-person at your location?
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Via Zoom
In-person, on site.
Do you have any time limits or restrictions for your PD or ConEd trainings?
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We can only schedule 1 hour at a time.
We can only schedule 90 Min at a time.
We can schedule 2 hours at a time.
We have no time restrictions.
We have other time restrictions not listed.
Other-Time Restrictions
I am requesting training for:
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Adults only
Students or youth only
Adults and students/youth
How many adults do you anticipate receiving training?
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How many youth do you anticipate receiving training?
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Grade level of the youth or students receiving training?
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K-6
6-8
9-12
Post High School, Young Adults
Why are you seeking a consultation/training from OUT Maine at this time?
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Additional information to share?
Has your school or organization recently conducted a survey or other form of data collection that reported on the current climate regarding LGBTQ+ issues? Would you be willing to share your anonymous results with OUT Maine to inform our assessment of your training needs? Please upload any relevant files here.
Where did you hear about OUT Maine?
Notifications
I would like to receive updates about the following
Youth programs
Training opportunities
OUT Maine Newsletter
