This survey is intended to help increase awareness about GlobalAge and to encourage participation by offering programs and services members want.  It will provide us a better understanding of 1) what is important to you and 2) your level of interest in participating.

Demographics (any or all of these questions are optional)  

Name:  _________________________________________   

Current Role/Title:  ________________________________________

Business/Location  __________________________________________________________________   

Time at company __________

Self-identified as (circle closest one):    Gay    Lesbian    Bisexual    Straight Ally    Questioning    Two Spirit    Other ______________

Gender-identified as (circle one):  Male   Female   Intersex   Transsexual   Transgender   (If Transsexual or Transgender: MTF or FTM)

Age (circle one):  18-25    26-35    36-45    46-55    56-65  

Do you have children? Y/N    (If Yes, how many? ____)

Racial/ethnic-identified as (circle closest one):   

African Descent / Black    European Descent / White    Spanish/Hispanic    Asian    Middle Eastern    Pacific Islander    Native American

Past Participation

1. How did you hear about GlobalAge and how do you follow GlobalAge developments?  (Check all that apply)

____  Word of mouth from my direct manager or a co-worker.

____  Saw a GlobalAge flyer.  Where?  __________________________________________________

____  Recommended by an HR or Diversity representative.

____  It was mentioned in a business or staff meeting.

____  Saw the information at a Pride event or National Conference.  Which one?  _____________________________________

____  Other (Please explain) ______________________________________________________________________________

2a. Have you attended/participated in GlobalAge activities (e.g., meetings, pride event, AIDS Walk)?   Yes  /  No

2b. If Yes, which events:  _____________________________________________________________________________________

2c.  If No, please indicate the reason(s) you may have not attended/participated.  (Check all that apply)

____  Did not know the group existed or about the events

____  Too busy to attend any events or participate

____  Did not know how to join

____  Did not see any benefit

____  Timing of events did not work for me

____  Uncomfortable being part of a GLBT group at work

____  Afraid of some sort of negative job action or loss of work-related friendships if participated

____  Did not know anyone

____  Other (Please explain) ______________________________________________________________________________

Future Ideas and Participation

3. I would like for GlobalAge to: (Check all that apply)

_____  Provide opportunities to meet, exchange views, and socialize with other people (TGIFs, Dinner “out”, Holiday Potluck, etc.)

_____  Elevate the visibility of GLBT concerns and Educate about GBLT workplace issues within GE

_____  Supply information regarding current GLBT workplace issues

_____  Help with career management & networking, professional development, mentoring & coaching, financial planning, etc.

_____  Other (Please specify) _____________________________________________________________________________

4. Which item(s) that you checked in Question #3 would you be willing to help coordinate?  ________________________________

5a. In general, what dates or times are best for you for GlobalAge T-con events?  (Check all the apply.)

_____  Weekdays (Mon-Fri)                                       ____  During workday lunch times

_____  Weekends (Saturdays)                                               ____  Before work (Early AM)

_____  Weekends (Sundays)                                                 ____  After work (Evenings)

_____  Other (Please specify) _____________________________________________________________________________

5b. In general, what dates or times are best for you for GlobalAge in-person events?  (Check all the apply and indicate your location.)

_____  Weekdays (Mon-Fri)                                       ____  During workday lunch times

_____  Weekends (Saturdays)                                               ____  Before work (Early AM)

_____  Weekends (Sundays)                                                 ____  After work (Evenings)

_____  Other (Please specify) ___________________________  Location___________________________________________

6. Are you willing to help with the leadership of GlobalAge including strategy and planning meetings, publicity, growing membership? Yes / No           If Yes, in what ways?  ___________________________________________________________________________

7.  Please describe any experience or involvement you have had with the Gay, Lesbian, Bisexual, and Transgender (GLBT) community. You may include any personal relationships (family members, friends, co-workers, etc.) which have shaped your viewpoint of GLBT issues. ___________________________________________________________________________

8.  Many corporations across the country have openly "out" employee organizations. Many GLBT employees do not feel safe in "coming out" as GLBT let alone pushing for acceptance in the workplace. What have you done (or would you do) to foster a climate to allow employees to feel safe being themselves? ___________________________________________________________________________

9.  Other comments and suggestions. ___________________________________________________________________________

Please return this page by email to: GlobalAge1@earthlink.net

GlobalAge respects its members’ confidences.  Thank you for your time and input !!!!