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Connections: Healthy Relationships with Family, Friends, and Partners

Connections is an in-person course that consists of 6 classes sponsored by Independence Northwest. This class is about relationships and sexual health and will help you reach out and build stronger connections with the people you care about. The Connections class will give you tools to be safe and happy in your relationships.

Please note that attendance at every class in the series is important because each class builds on the one before.

If you have any questions, don't hesitate to reach out to one of the instructors (Corinne or Alice) by emailing us at connectionspeople@gmail.com.

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* 1. What is your name?

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* 2. Please share your contact information with us.

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* 3. If you would like to add an additional contact for us to communicate with (such as a family member, support person, provider, or friend) please share their name, phone, and email address below.

If not, just skip this question and go to the next one.

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* 4. What is your brokerage Personal Agent's name?

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* 5. Which brokerage do you receive services from?

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* 6. What is your Personal Agent's email address?

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* 7. What is your age?

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* 8. What are your preferred personal pronouns?

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* 9. In your own words, why do you want to take this class?

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* 10. What types of relationships do you want to learn more about?

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* 11. How do you feel about Connection Class Topic #1?

"Communication - understanding how we can better communicate with friends, family, and partners"

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* 12. How do you feel about Connection Class Topic #2?

"What is public and what is private?"

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* 13. How do you feel about Connection Class Topic #3?

"What is a healthy relationship? What is an unhealthy relationship?"

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* 14. How do you feel about Connection Class Topic #4?

"Gender identity and sexual orientation"

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* 15. How do you feel about Connection Class Topic #5?

"Using social media: internet and phone safety"

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* 16. How do you feel about Connection Class Topic #6?

"Moving from friend to partner (romantic feelings, sexual feelings, dating, intimacy)"

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* 17. How do you feel about Connection Class Topic #7?

Consent. What is yes? What is no? Saying NO.

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* 18. How do you feel about Connection Class Topic #8?

"Exploitation and abuse in relationships"

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* 19. How do you feel about Connection Class Topic #9?

"Understanding our bodies (anatomy, sex, and sexual health)"

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* 20. How do you feel about Connection Class Topic #10?

"Reproduction (birth control, pregnancy, parenthood)"

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* 21. Do you have any other topics you'd like us to address?

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* 22. Please us know of anything we should be aware of to ensure your safety and success in class. Are there accommodations that help you participate and learn best in a classroom setting?

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* 23. How do you feel about being in a classroom setting and learning with other people?

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* 24. Do you have any medical concerns or protocols the instructor should be aware of to ensure your safety?

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* 25. Do you have a behavior support plan in place?

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* 26. Do you need a support person to be present to support you with medical or communication needs?

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* 27. How will you travel to the Independence Northwest office?

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* 28. Who completed this application?

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* 29. Please share contact information for who you would like us to contact in the event of an emergency.

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* 30. Do you have anything else you'd like to share with us?

(Note: You can always change answers from earlier in the application before submitting. Just scroll up and make changes!)

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* 31. By checking the box below, I understand and authorize Connections class instructors to communicate with my Personal Agent, family, support person, providers or anyone else listed in question #3 regarding this application. I understand that this release is required in order to provide the best possible class experience.

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