UM Flint Take Back the Night Survivor Speak Out Application
Annual Take Back the Night is a national event to raise awareness, share and uplift survivor experience, and commit to advocacy and action within the Flint community and across Michigan. Survivor Speak Out is one way in which the Center for Gender and Sexuality seeks to facilitate the community support of survivors, by providing an inclusive space for people affected by sexual violence to share statements of survivorship. The March and Speak Out will be held on April 14th at 6pm in the UCEN Happenings Room.
Please complete this form if you would like to partake in the Survivor Speak Out, and CGS will reach out to you individually for further information!
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Email *
Please enter your full name, including any preferred names. *
Please enter the pronouns that other people should use when referring to you.
Please enter an email and/or phone number that is best for us to contact you at. *
What is your affiliation with the University? *
Would you prefer to speak at this event, or would you rather have someone else speak for you? Please let us know your preference below. *
The Center for Gender and Sexuality values and promotes diversity and inclusion in our events. Are there any personal or social identities related to your art that you would like to share with us?
If your attendance to or participation in this event requires accommodations, please let us know what would be helpful for you here! (Ex., sign language interpretation, wheelchair access, etc.)
If you have any questions, comments, or concerns for the event hosts, please write them here.
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