Secure Client Questionnaire - Privileged and Confidential - Subject to Attorney Client Privilege

Client Questionnaire

Privileged and Confidential - Subject to Attorney-Client Privilege

Name (To Be Used For Project)
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Physical Address in January and February 2021*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Date of Birth*
Date Format: MM slash DD slash YYYY
Religious Affiliation*
Pronouns*
Gender Identity*
Sexual Orientation*
Race/Ethnicity
Name and Main Location of School(s)*
School Start Date
MM
DD
YYYY
School End Date
MM
DD
YYYY
Did you graduate?*
- Yes
- No
Did you receive any federal financial aid for this school? (Grants, Scholarships, Loans, Work Study, etc.)*
- Yes
- No
If yes, please describe.
Have you ever paid Federal Income Taxes in the United States?*
Is your school aware of your gender identity or sexual orientation?*
- Yes
- No
- I don't know
Why did you choose this school or college?*
In your own words, please describe your relationship with your school when it comes to your gender identity or sexual orientation. This includes whether you feel safe coming out on campus, whether you feel supported, any disciplinary action by the school or any actions of faculty, staff, and peers.
Is there a LBGTIA+ group on campus?*
Were you involved with this group?
- Yes
- No
- n/a
How does your school's policies on sexual orientation and gender identity make you feel?*
Have you been harmed because of your school's policies on gender identity and sexual orientation, including anxiety, depression, sexual assault, not feeling safe enough to come out at school, you were subjected to conversion therapy or forced into counseling, you are worried about future employment because of your school's views, etc.*
Why have you agreed to participate in this lawsuit?*