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LGBTQ+ OurSpace Program Interest Form
Hi! Thank you so much for your interest in the LGBTQ+ OurSpace Program. It will definitely be a fun summer filled with community and amazing activities! Please fill out the form below if you are interested in joining the program. (Only share what you feel comfortable with sharing!)
Feel free to email us with any questions or concerns:
Netter-OurSpace@sas.upenn.edu
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* Indicates required question
Email
*
Your email
Name (First & Last)
*
Your answer
Pronouns
Your answer
Grade
*
Your answer
School
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Best Contact Method
*
Phone
Email
Other:
Are comfortable with us sharing program information with your parent or guardian?
Yes
No
Other:
Clear selection
Do you prefer virtual or in-person programming?
Virtual
In-Person
Clear selection
What are some things you want from OurSpace this summer? For example: college/career information, fun games and activities, field trips, academic enrichment activities, etc.
Your answer
What can we do to help make OurSpace safe and comfortable for you?
Your answer
Do you see any barriers to participation? For example: traveling, scheduling, etc.
Your answer
What days/times work for you? Currently, we are thinking about having the program days to be on Monday, Wednesday, and Friday around 4pm-6pm.
Your answer
Is there anything else you would like us to know?
Your answer
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