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Trans Advocate Services Form

Everything shared on this form will be confidential and go directly to the Community Facilitator at LGBTQ Allyship. We will not share your information without your express consent.

Contact Information

Name

First Name

Last Name

What are your pronouns?

Verify Email

Phone

Which way do you want us to contact you?

Is it ok to leave a message on voicemail?

Yes

Address

Address Line 1

Address Line 2

City

State

State/Province

ZIP/Postal Code

Country

Do you need interpreting services?

What kind of interpretation services do you need?

(e.g. Spanish, Tagalog, Somali, Vietnamese, American Sign Language, etc)

Are you represented by a union?

What do you need help with?

You can check more than one thing and we will talk about it at your appointment.

Pay issue

Sick and Safe Time Issue

Discrimination Issue

Harassment at work

Safety Concern at work

Scheduling Issue

Health Benefits Question

What's going on?

You can say as little or as much as you want on this form, and we'll follow up with you

When are the best times to contact you?

Mornings (between 8 a.m. and 11:59 a.m.)

Afternoons (between 12:00 p.m. and 4:59 p.m.)

Evenings (between 5:00 p.m. and 8:00 p.m.)

Other (please indicate below)

If you chose 'other' for your availability, please specify below

What kind of assistance are you looking for?

More information about labor standards

More information on what options are about addressing work violations

Assistance navigating Office of Labor Standards/Civil Rights processes

Someone to advocate on your behalf

A trans and gender non-conforming advocate to interface with these offices on your behalf

Preferred Name

What name do you go by?

How did you hear about us?