Peer to Peer Registration

Our Peer Support Program is specifically geared towards helping to provide support, resources and access to gender affirming care to the Trans and Non-Binary communities. Pride Peers have an opportunity to gain connection, support, knowledge, and insignt from amazing Pride Mentors! Are you looking for a supportive relationship as you naviagte your gender journey or gender health journey? Would you like to connect to someone with shared experience? What about connecting to someone who is there to empower you and provide opportunities to build resilience and adaptability? By becomeing a Pride Peer you will have the opportunity to access visibility, intersectional inclusion, guidance, and support from other transgender or gender diverse Pride Mentors!

We appreciate your enthusiasm to be a participant in our Pride Peer Support Program at the Utah Pride Center! Please respond to the following questions and a member of the Utah Pride Center will be in contact with you after you have submitted this form. Please give our Peer Support Team up to 72 hours to connect with you. If you do not hear from our peer support team within 72 hours, please direct any questions or concerns to [email protected]

Full Chosen Name *

Email Address *

Phone Number *

Date of Birth *

Pronouns *

Which method of communication is the most convenient way for us to contact you? *

Call

Text

Email

Which of the following best represents your sexual orientation? *

Gender Identity? *

Ethnicity? (select multiple if applicable) *

White

Black (African American, African, Jamaican, etc)

Native Hawaiian or Pacific Islander (Samoan, Tongan, Fijian, etc)

Asian (Chinese, Japanese, Filipino, Indian, Korean, etc)

Indigenous or Alaskan Native

Latino/Hispanic

Biracial

Multi-racial

Ethnicity not represented in options

Age *

Are you currently utilizing services or programs at the Utah Pride Center? *

Yes, I am in support group(s)

Yes, I attend events or activities

Yes, I am a volunteer for the Utah Pride Center

Yes, I obtain services from the Mental Health Department

Yes, I obtain services from the Community Health Department

Yes, I obtain services from the Youth and Family Department

Yes, I come to the center and use the centers services

No, I do not currently utilize services or programs at the Utah Pride Center

Are you interested in finding support or learning more about HRTs? If so, please specify.

Other *

Are you interested in finding support or learning more regarding Trans Masculine Surgery Options? If so, please specify.

Other *

Are you interested in finding support or learning more regarding Trans Feminine Surgery Options? If so, please specify.

Other *

Would you like to subscribe to: *

Email newsletter

Physical mail

Both

None

Peer Support Participant Registration

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