Placement Application

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Placement Application

Please fill out the following form if you wish to participate in the Q'nnect program for the Princeton LGBT community. Students, staff, and faculty are encourage to apply. There are a dozen questions, the last four of which are optional. Information collected from this form will be kept strictly confidential. If you have any questions, please feel free to email lgbtasst@princeton.edu.

Name:

Email:

Are you a member of the student, faculty, or staff population?

Undergraduate Student
Graduate Student
Faculty
Staff

What is your year, department, and/or office?

Please list a few of your interests, hobbies, activities, etc.

What is your hometown? (You may list a city, state, or country)

What do you wish to get out of this program? What would you like to contribute?

Are there any important characteristics that we should take into account when placing you in a group? (i.e. area of study, gender, race, where you live on campus, religion, orientation, campus group affiliations, etc.)

Is there anything else you would like us to know?

The last four questions are optional.

How do you define your sexual orientation?

How do you define your gender identity?

What is your racial and/or ethnic identity?

Do you have any particular religious and/or spiritual affiliation?

In submitting your application, you agree to the following:

I understand that this program seeks to provide support and mentorship for members of the LGBT community. I am aware that there is no obligation to spend money when meeting with my group. Romantic involvement with members of my pod is inappropriate and grounds for dismissal from the program. If I have any questions or concerns, I know I can contact Debbie Bazarsky or Andy Cofino at the LGBT Center.