Please complete the following form if you would like to receive ongoing information from Positive Black Women. Demographic questions are optional and all members of the GVSU community are invited to participate. For the most up-to-date contact information for questions or to learn more about Positive Black Women, please see the association website at www.gvsu.edu/pbw.

First Name *

Last Name *

Pronouns
She/her/hers
They/them/theirs
He/him/his
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Email *

Phone

GVSU Affiliation *
Faculty
Staff
Graduate Student
Undergraduate Student
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Race or Ethnicity
Asian or Asian American (including Pacific Islander)
Black or African American
Hispanic or Latino
Native American or American Indian
White
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Do you identify as (select one)
- Select Option Cisgender (you identify with the gender you were assigned at birth) Transgender (you identify with a gender different from what you were assigned at birth)

Gender identity (select all that apply)
Woman
Man
Non-binary
Genderqueer
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Do you identify as LGBTQ+?
- Select Option Yes No Not listed Please specify a value for Do you identify as LGBTQ+?

Do you identify as International?
- Select Option Yes No Not listed Please specify a value for Do you identify as International?

Questions or Comments