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Safe and Supportive Environments for LGBTQ Students


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Please provide the following information to complete your registration.
First Name:*
Last Name:*
Address:*
City:*
State:*
County:*
Zipcode:*
Your Email:*
Phone number:*
Degree:
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Please enter your password again to confirm:
Your employer or organization:*
Job Title:*
Other specify:*
If you are a teacher, please choose the subject you teach.*
Other
Your Employment Setting:*
Other specify:*
Are you interested in participating in the Sexual Health Educator (SHE) Training Program as described  here?
Be sure to select 'Yes' if you are interested in working towards the certificate of completion.*
Are you sure you do not want to participate in the Sexual Health Educator (SHE) Training Program? (If you select YES to this question, if you previously enrolled in the program, we will remove you from the Learning Track.) PLEASE NOTE: If you said NO to participating in the Sexual Health Educator (SHE) Training Program by mistake, please change your response to YES to the question above.*
How did you learn about the SHE Training Program? (Select all that apply)*
Other
What is the best way to inform you about new training opportunities? (select all that apply)*
Other
Why are you participating in the SHE Training Program? (select all that apply)*
Other
What do you plan to do with the SHE Training Program Certificate of Completion?*
Other
Do you currently provide sexual health education to youth in a classroom setting in California?*
Does your school provide curricula or supplementary materials that include HIV, STD, or pregnancy prevention information that is relevant to lesbian, gay, bisexual, transgender, and questioning youth (e.g., curricula or materials that use inclusive language or terminology)? (Mark one response.)*
During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, and any other kind of in-service) on each of the following topics? Choose all that apply.*
During this school year, did/will teachers in your school teach each of the following sexual health topics in a required course for students? Choose all that apply.*
My school provides students with referrals to organizations or health care professionals not on school property for STD testing.*
My school provides students with referrals to organizations or health care professionals not on school property for STD treatment.*
My school provides students with referrals to organizations or health care professionals not on school property for provision of condoms.*
My school provides students with referrals to organizations or health care professionals not on school property for pregnancy testing.*
My school provides students with referrals to organizations or health care professionals not on school property for provision of contraceptives other than condoms (e.g. birth control pill, birth control shot, intrauterine device [IUD]).*
My school provides students with referrals to organizations or health care professionals not on school property for prenatal care.*
True or false: young people may be biologically more susceptible to getting an STD compared to older people because of their anatomy.  *
Which of the following topics are instructional requirements of the California Healthy Youth Act? Select all that apply.*
Which of the following services can a minor in California consent to without parent/guardian permission or notification? Select all that apply.*
True or False: Lesbian, Gay, Bisexual, Transgender and/or Questioning (LGBTQ) students report higher rates of pregnancy than non-LGBTQ students.*
To what level do you agree with the following statement:

“I believe it is the role of the school to provide all students with inclusive, comprehensive sexual health education.” Please choose one response.

*
How would you describe the way your school/organization ensures unbiased, comprehensive sexual health education is taught to students? Please choose one response.*
On a scale of 1 to 5, with 1 being no comfort and 5 being extremely comfortable, please rate your current comfort level teaching inclusive, comprehensive sexual health education to young people.*

What are the reasons you don't feel completely comfortable teaching inclusive, comprehensive sexual health education to young people? Please explain.

*

What are the reasons you don't feel completely comfortable teaching inclusive, comprehensive sexual health education to young people? Please explain.

*

What are the reasons you don't feel completely comfortable teaching inclusive, comprehensive sexual health education to young people? Please explain.

*
Please explain why you feel comfortable teaching inclusive, comprehensive sexual health education to young people? (E.g. you have many years of experience, you recently received professional development in this area)*
Please explain why you feel comfortable teaching inclusive, comprehensive sexual health education to young people? (E.g. you have many years of experience, you recently received professional development in this area)*
Do you anticipate any challenges to completing the SHE Training Program?*
Please share what challenges you anticipate to completing the SHE Training Program.*
In your own words, please tell us what you hope to get out of the coursework that is required to complete the SHE Training Program?*
Thank you for taking the time to provide us with this information.

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