URE Needs Your Support to Launch the Blue Roots Residency

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Name* This field is required.

First Name

Middle Name

Last Name

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Pronouns

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Email Address* This field is required.

example@example.com

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Phone Number

Please enter a valid phone number.

5

City* This field is required.

6

State* This field is required.

7

Organization or Business Name

8

Website and/or Social Media

10

If you selected Other, please describe

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Describe the support, resources, services, skills, or opportunities you would like to offer* This field is required.

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How often are you available to provide this support?* This field is required.

One-time

Monthly

Ongoing

Project-Based

Not Sure Yet

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Please share any limitations, boundaries, or conditions we should know about

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Are you interested in hosting a passenger during the residency?* This field is required.

Yes

No

Maybe

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Describe the space you may be able to offer

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City where the space is located

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How many weeks would you be available to host?

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What services do you provide?* This field is required.

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Who do you primarily serve?* This field is required.

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Do you have experience supporting Black Trans and Gender Nonconforming communities?* This field is required.

Yes

No

Some Experience

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What is your approach to care and support?* This field is required.

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What inspires you to support the Blue Roots Residency?* This field is required.

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Anything else you’d like to share with our team

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Would you like to receive updates about the residency and future opportunities to support?* This field is required.

Yes

No