BQPlus Programs Date(Required) MM slash DD slash YYYY Name(Required) First (chosen/preferred) Last Date of Birth(Required) Month Day Year Valid Email Address(Required) What is your gender identity?(Required) Cisgender Male (assigned male at birth) Cisgender Female (assigned female at birth) Transgender Male Transgender Female Intersex Gender Nonconforming/Non-binary Other What is your sexual orientation?(Required) Heterosexual Gay Bisexual Same Gender Loving Queer Asexual Other What is your race/ethinicity?(Required) Black / African American Hispanic / Latinx Native American / Indigenous Hawaiian / Pacific Islander White Asian Other What is your age?(Required)Which social media platform(s) are you following us on?(Required) Facebook: The Normal Anomaly Twitter: @danormalanomaly Instagram: @thenormalanomaly N/A Select AllCheck all that apply.Do you know your HIV status?(Required) Yes, HIV positive Yes, HIV negative No, unsure Never been tested for HIV before Prefer not to disclose Are you familiar with PrEP?(Required) Yes, I am currently taking PrEP Yes, but not currently taking PrEP No, have little information on PrEP No, never heard of PrEP Interested in P.O.W.R- a program that offers person living with HIV training around advocacy, empowerment and meaningful involvement?(Required) Yes No Interested in C.O.R.E- a program offering community members a space to address challenges with communities existing on the intersections of black, queer and plus?(Required) Yes No Interested in D.A.T.E Night- a program that offers a night of inclusive fun, safer sex education, advocacy, and agency?(Required) Yes No Would you like to receive feed back personally about your questions, comments or concerns via the contact information you provided?(Required) Yes No N/A If you have any questions, comments or concerns you have for The Normal Anomaly Initiative please place them here.Anti-SPAM: What is 6 + 4?(Required) PhoneThis field is for validation purposes and should be left unchanged.
