/ Continuing Education/ TransActive Support Group Application

TransActive Support Group Application

Please provide the information requested below. Once you’ve submitted the completed form, a member of our staff will contact you to provide further information.

If you are self-registering as a Vanguard member (age 14-17) without a parent or guardian, please register yourself under adult 18+ but note that you will be attending Vanguard.

All fields marked with asterisk (*) are required.

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Youth first name (assigned or chosen):

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Youth last name:

date field

Birthdate:

select menu field

They identify as:

select menu field

Gender pronoun:

text field

If other, please enter the pronouns used:

text field

Youth's age:

select menu field

Group they are attending:

header field

required text field

First name (assigned or chosen):*

required text field

Last name:*

required select menu field

You identify as:*

required select menu field

Gender pronoun:*

text field

If other, please enter the pronouns used:

required text field

Relationship to youth participant:*

required select menu field

Group you are attending:*

date field

Self-Registering Vanguard Birthdate

If you are a Vanguard member self registering, please provide your birth date.

required text field

Phone number:*

required radio button field

Is it safe for us to leave a message and give our organization name?:*

Yes

required e-mail address field

Email:*

header field

text field

First name (assigned or chosen):

text field

Last name:

select menu field

They identify as:

select menu field

Gender pronoun:

text field

If other, please enter the pronoun used:

text field

Relationship to youth participant:

select menu field

Group they are attending:

text field

Phone number:

radio button field

Is it safe for us to leave a message and give our organization name?:

Yes

e-mail address field

Email:

header field

paragraph field

If there are no additional minor participants, please scroll to the bottom of the page to submit your enrollment request.

text field

First name (assigned or chosen):

text field

Last name:

date field

Birthdate:

select menu field

They identify as:

select menu field

Gender pronoun:

text field

If other, please enter the pronoun used:

text field

Youth's age:

select menu field

Group they are attending:

textarea field

Enter additional minors/children (if any) below:

paragraph field

PLEASE NOTE: Upon receipt of this form, a member of the TransActive Gender Project staff will contact you within 72-hours at the email listed to confirm your submission and provide further information.

Link (required)