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Name
*
First Name
Last Name
Email
*
I have worked with many clients from the following communities:
*
Sex Workers
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Folks of Color
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
LGBT+
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Nonbinary or Gender Questioning
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Undocumented Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Folks with physical disabilities
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel confident about my knowledge pertaining to the following communities
*
Sex Work
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
LGBT+
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Nonbinary or Gender Questioning
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Undocumented Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Folks with physical disabilities
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel comfortable working with clients who are members of the following communities:
*
Sex Work
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Folks of Color
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
LGBT+
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Nonbinary or Gender Questioning
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Undocumented Immigrants
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Folks with physical disabilities
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have done work around my own white privilege
*Only answer if you identify as white
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am comfortable working with clients who would like to work on their own white privilege
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Activist burnout:
I have done clinical work around activist burnout
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have personal experience with activist burnout
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Thank you!