Day of Silence - Register

COLLEGE REGISTRATION FORM

This form is for students and teachers working to organize the Day of Silence in their college or university.

If you are from a community group, please visit our Organizational Endorsement page instead.

To register, simply fill out the form below as completely as possible. The Day of Silence does not sell or trade your personal information, and only shares with others with your permission. Please review our Privacy Policy for more information.

A. Individual Contact Information - Please provide a mailing address, phone number and email where it is safe for you to receive Day of Silence and USSA materials.
	Name:
	Mailing Address:
	City, State & Zip:
	Phone (+ area code):
	Email:
	College Graduation Year:
	Directory - May we share your information with others organizing the Day of Silence in your local area?
B. School & Group Information
	School Name:
	Which best describes your role?


	Group's Name (i.e.; Queer Union, Amnesty, Student Union, etc):

	About how many members does your group have?

	Do you want your school name listed in the online directory of participating schools?

C. Other - Please use the space provided to answer the following questions. Please limit your comments to 50 words or less.
	What, if any, activities are you, or your group, planning around the Day of Silence?

	Are there any questions/comments you’d like to share?

		Would you like to be subscribed to QSEP, an email-listserv specifically for college students working to improve the lives of queer students in higher education?
	Please share how you heard about the Day of Silence?