QUEERSPACE Hangouts Youth Referral

Welcome

Thank you for referring an LGBTQ+ youth to the QUEERSPACE hangouts mentorship program. We are happy to accept referrals from an agency or an adult community member in the youth's network of support. If you are an LGBTQ+ youth, you can have your parent or caregiver fill out the form on your behalf!

If you have questions about this form, the referral process or our mentorship program, please send an inquiry to info@queerspacecollective.org.

Youth Criteria
1) ages 12-17; 2) wants an LGBTQ+ mentor 3) is willing to meet 2-3 times per month with the mentor and participate in monthly group events; 4) resides in the Twin Cities or the Saint Cloud Metro Areas.

Program Selection

Are you applying for the Twin Cities Metropolitan Area or the Saint Cloud Area? *This question is required.

Referring Agency or Community Member
Information will not be shared outside of QUEERSPACE collective.

Name of Referring Person *This question is required.

Place of Employment *This question is required.

Position/Title *This question is required.

Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Email Address *This question is required.

Phone Number *This question is required.

Relationship with LGBTQ+ youth *This question is required.