International LGBTQI Elected Officials Survey

Victory Institute is working to identify LGBTQI elected officials around the globe. If you are an LGBTQI elected official, complete and submit the following questionnaire.

Demographics
Name*
First Last
Email*
Phone*
Skype User ID
Date of Birth*
MM slash DD slash YYYY
Which of these terms best describes your sexual orientation?*
- Bisexual
- Lesbian
- Gay
- Queer
- Pansexual
- Same-gender loving
- Asexual
- Heterosexual
Which of these terms best describes your gender identity?*
- Transgender woman
- Transgender man
- Woman
- Man
- Gender non-conforming
- Genderqueer/Non-binary
- Intersex
- Two spirit
Race / Ethnicity*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Details about your public office
What kind of public office are you holding?*
- I am an elected official (I won an election)
- I am an appointed official (I got hire for the Administration to carry out some portion of a government's sovereign powers
What is the level of the office you are holding?*
- Nation wide position
- State level / regional position
- Local level position
Name and position of the office you are holding
For example, Congresswoman at the House of Representatives
Date when you took office (month & year)*
Date when your term expires (month & year)*
Expertise as an LGBTQI public officer
Areas of LGBTQI Expertise (choose all that apply)*
- Marriage Equality / Civil union
- Immigration / Refugees
- Transgender Rights
- HIV
- Intersex rights
- LGBTI Youth
- Housing/Homelessness
- Coming Out
- Education
- Law reform/Legal
- Religion
- Inclusive public services / service providers
- Other (please describe below)
If selected "other" for areas of expertise, please describe:
Would you like to advise other out or allied elected officials in areas related to your expertise on equality for LGBTQI people?*
- Yes
- No
What have you been able to accomplish for the LGBTQI community through your current or past position?
Feel free to share any relevant information, including links to any news
Name
This field is for validation purposes and should be left unchanged.

Δ

1225 I (Eye) Street NW, Suite 525
Washington, DC 20005

Voice: 202.VICTORY
Fax: 202.289.3863

Home
Contact
Privacy Policy
Terms of Use

Close Modal

International LGBTQI Elected Officials Survey

Demographics

Details about your public office

Expertise as an LGBTQI public officer