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LGBT/HIV Discrimination Legal Intake
Intake Intake
This field is automatically calculated and required for submission.
This is a deprecated field.
Please include the area code with your phone number

Intake Source
If Other, please fill in the Intake Source.
Voicemail


ACLU calling
We don't want to cause any problems for you at home. Can we say the ACLU is calling?

Contact method Required


School Required
Are you contacting us for a matter related to school or being a student?

If yes, what is the name of the school?

In what state did the incident occur?

This is a deprecated field.
How would you categorize the discrimination?



Demographic Information
In order to get a better sense of the communities and individuals
we serve, we are collecting additional demographic information.
Providing us with this information is optional, but it will help us
to improve the work that we do. If you are filling out this form on
behalf of someone else, please enter their demographic information.

Age Required

Ethnicity Required


Income Required


How many people are currently living your household (not including you)?

Outcome
Outcome of request
Subject Area
Gender pronoun Required
Potential Story for PubEd
Choose an epic to assign this issue to.
None
JIRA Software sprint field
Sexual Orientation Required
Gender Identity Required
Transgender Question Required