Let's Talk Month Registration
Thank you for registering for GCAPP's Let's Talk Month!
To better serve our communities, GCAPP collects the following demographic information.
Your decision to share personal demographic information is entirely voluntary; if you choose not to share there will be no penalty or consequences and you will still have full access to GCAPP’s services and resources.
All information you share is kept confidential to the full extent allowed by law. All data is secured within GCAPP’s database accessible only to the evaluation team and GCAPP staff.
What event(s) do you plan to attend?
Please select...
LTM- Internet Safety and Trafficking (Oct 25th)
LTM-Fatherhood Initiative Sexual and Mental Health Edition (Oct 27th)
Both events (Oct 25th and 27th)
First Name
Last Name
Please Select the Attributes that Describe You
Student
Teacher
Young Adult (18-24)
Youth (10-17)
Youth Serving Professional
Counselor
Parent/Caregiver
Other
Demographic Information
Race
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Black or African American
White/Caucasian
Hawaiian/Pacific Islander
Middle Eastern or North African
Asian
Native American or Alaska Native
Another Race or Not Listed
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Other Race
Do you identify as Hispanic, Latino, or Latinx?
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Yes
No
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Gender
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Man
Woman
Non-Binary
Transgender Man
Transgender Woman
Another Gender
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Other Gender
Personal Pronoun
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He
She
They
Ze
Another Pronoun
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Other Pronoun
Sexual Orientation
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Lesbian
Gay
Bisexual
Queer
Straight
Asexual
Another Orientation
Prefer Not to Answer
Other Orientation
County of Residence
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Appling
Atkinson
Bacon
Baker
Baldwin
Banks
Barrow
Bartow
Ben Hill
Berrien
Bibb
Bleckley
Brantley
Brooks
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Burke
Butts
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Camden
Candler
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Clay
Clayton
Clinch
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Coffee
Colquitt
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Early
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Elbert
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Evans
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Fayette
Floyd
Forsyth
Franklin
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Gilmer
Glascock
Glynn
Gordon
Grady
Greene
Gwinnett
Habersham
Hall
Hancock
Haralson
Harris
Hart
Heard
Henry
Houston
Irwin
Jackson
Jasper
Jeff Davis
Jefferson
Jenkins
Johnson
Jones
Lamar
Lanier
Laurens
Lee
Liberty
Lincoln
Long
Lowndes
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Macon
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McDuffie
McIntosh
Meriwether
Miller
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Morgan
Murray
Muscogee
Newton
Oconee
Oglethorpe
Paulding
Peach
Pickens
Pierce
Pike
Polk
Pulaski
Putnam
Quitman
Rabun
Randolph
Richmond
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Schley
Screven
Seminole
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Stewart
Sumter
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Union
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Contact Information
Phone
Email
Contact Information