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QWOCMAP Filmmaker Training Program Waiting List
Thank you for your interest in our free workshops! Please fill out this form completely. We request demographic information in order to better serve you, meet your needs, and match you to workshops that meet your interests.

First Name *
Last Name *
Email *
Gender *
With which of the following sexual orientations and romantic affiliations do you most identify? *
Are you of origen Latinx/origin ? *
With which of the following regions do you identify in terms of race, ethnicity, and nationality? (please select all that apply) *	African Diaspora Caribbean (eg, Bahamas, Puerto Rico) Central Africa (eg, Chad, Congo) Central America (eg, Guatemala, Honduras) Central Asia (eg, Kazakhstan, Uzbekistan) East Africa (eg, Kenya, Eritrea) East Asia (eg, China, Korea) First Nations/Native American/Indigenous people of North and South America Oceania - Hawaiian, Pacific Islands, Melanesia, Micronesia, Polynesia North Africa (eg, Egyptian, Moroccan) North America (eg, Mexico, Canada) Southern Africa (eg, Angola, Zambia) South America (eg, Chile, Peru, Venezuela) South Asia (eg, Sri Lanka, Pakistan) Southeast Asia (eg, Thailand, Vietnam) Southwest/West Asia (eg, Afghan, Turkish) West Africa (eg, Ghana, Nigeria) Europe - West, South, North, East
Please note specific race, ethnic and national groups and tribal/band affiliations with which you identify: (ie, Chiricahua Apache; Singaporean & Teo Chew/Hokkien; Jewish & Peruvian, etc.) *
What was your first language? *
What is your age? *
What is your estimated annual household income? *
What is your level of education? *
Where do you reside? *
Are you part of the disability community? *	Yes No
I am interested in the following workshops:	Formerly incarcerated LBTQ people of color Disabled & Sick LBTQ people of color LBTQ women of color survivors of violence & trauma LBTQ Muslims of Color Two Spirits in Indian Country Spanish-language Native Hawaiian & Pacific Islander Transgender women of color Transgender men of color LBTQ Youth of Color LBTQ Elders of Color
By checking here *	I want to be on the waiting list.

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