Thank you for your interest in joining the LGBTQ+ Survey Project Advisory Committee. This Committee is intended to meet quarterly.

Please fill out the form below and we will connect with you soon. We will accept forms until the Committee is filled. Not all inquiries will result in a committee position.

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Gender Identification *

Pronouns

Primary language (and any others) *

Ethnicity/National Origin *

Accessibility needs

Academic Degrees/Certificates/Other Education *

Professional Affiliation/Title. If retired, include previous experience. *

Publications/Awards/Personal Websites or Social Media *

Volunteerism and/or Board Experience *

Part of Connecticut you feel a personal connection to and why *

Describe any experience with the following areas: historic Preservation, history, fundraising, advocacy, community organizing, GIS, website management *

What areas would you be most interested in assisting PCT? *

• Fundraising
• Fiduciary
• Advocacy
• Communications/Social Media
• Event Planning
• Research and Storytelling
• Community Engagement
• Staff/Organizational Support
• Other:

Other

Why are you interested in joining the PCT LGBTQ Advisory Board?

Is there anything else you'd like us to know about you?

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