ShoutOut Austin! LGBTQIA+ Quality of Life Study

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ShoutOut Austin! LGBTQIA+ Quality of Life Study
The City of Austin’s LGBTQ Quality of Life Advisory Commission and Equity Office need your help to understand the needs of the LGBTQIA+ communities to better support and advocate to Austin’s City Council on their behalf. The responses you provide here will inform Austin’s City Council.
PDF Instructions:
Participants can use this fillable PDF to complete the survey. Be sure you use the save button at the PDF tool bar when finished. Save to your computer then email the file. Completed surveys (PDF) should be emailed to [email protected] before May 1, 2021.
You can also print this survey and fill out with pencil/pen. Paper surveys can be mailed to: Management Service - Equity Office P.O. Box 1088 Austin, TX 78767 or can be dropped off at Austin City Hall Equity Office before May 1, 2021. You may also complete the survey online with a smart phone, tablet, or computer at
Survey Details: • ONLY ONE SURVEY PER PERSON CAN BE SUBMITTED. • Survey respondents must currently reside in Travis, Hays, Bastrop, or Williamson County. • This is an anonymous survey. Your identity will not be linked to your responses. • This survey will take about 25 minutes to complete. • All questions (except demographic questions) are optional and all responses are confidential. We are asking demographic information (e.g. race/ethnicity, orientation, identity) in this survey to help us learn about the experiences of each identity group represented in our social sector. These few required questions are marked with a red asterisk. Only aggregated data will be shared publicly, and any quotes from the comment section at the end of the survey will be attributed anonymously. • We are using Qualtrics to conduct the survey. Please see their privacy policy for information on how they store and protect data at • If you have questions about this survey and how data will be used, please contact Charles Robbins at [email protected]
Some of the questions in this survey are sensitive in nature and may bring up uncomfortable feelings. The purpose for asking these questions is to better understand what may impact the quality of your life and others in the community. We understand that thinking about certain experiences may be difficult; we honor your feelings and thank you for your honesty and candor. Also, please know that we and have provided some resources at the end of this survey should you wish to seek support.
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Q2.3 *What zip code do you live in? ________________________________________________________________
Q2.5 *What is your age?
o 12-17 years old o 18-24 years old o 25-34 years old o 35-44 years old o 45-54 years old o 55-64 years old o 65-74 years old o 75 years or older
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Q2.6 *What is your racial and ethnic category? Select one.
o Asian or Asian American. A person having descendants in the Far East, Southeast
Asia or the Indian subcontinent. Includes Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
o Black, African, or African American. A person having descendants in any of the black
racial groups of Africa. Includes descendants of enslaved black people, black immigrants, and terms such as "Haitian” and “Afro-Caribbean”.
o Hispanic, Latino/a/e/x, or Latin American. A person having descendants in Cuba,
Mexico, Puerto Rico, Dominican Republic, South or Central America, or other Latin American countries and dependencies.
o Middle Eastern or Arab American. A person having origins in the Middle East region or
Arab heritage. Includes Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Qatar, Palestine, Saudi, Arabia, Sudan, Syria, Somalia, Tunisia, United Arab Emirates, and Yemen.
o Multi-racial. A person that fits into more than one racial or ethnic category o Native American, Indigenous, or Native Alaskan. A person having descendants in
any of the original peoples of North, Central, or South America.
o Native Hawaiian or Other Pacific Islander. A person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
o White or European American. A person having descendants in Europe or Western
o Other (please specify): ________________________________________________
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Q2.8 *What BEST describes your sexual orientation? Select one.
o Asexual o Bisexual o Gay o Heterosexual or Straight o Lesbian o Pansexual o Questioning o Queer o Fluid o Prefer not to say o Other (please specify): ________________________________________________
Q2.8.1 Do you identify as intersex?
o Yes o No
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Q2.9 *What best describes your current gender identity? Select one.
Definitions: • Agender- denoting or relating to a person who does not have a gender identity or identifies
as gender neutral. • Cisgender- a term used to describe a person whose gender identity aligns with those
typically associated with the sex assigned to them at birth. • Gender-fluid- a person who does not identify with a single fixed gender or has a fluid or
unfixed gender identity. • Genderqueer- a term used to describe people who typically reject notions of static
categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as "genderqueer" may see themselves as being both male and female, neither male nor female or as falling completely outside these categories. • Gender non-conforming- a broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category. While many also identify as transgender, not all gender nonconforming people do. • Transgender- an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. • Two-spirit or other Native Identity- refers to a person who identifies as having both a masculine and a feminine spirit and is used by some Indigenous people to describe their sexual, gender and/or spiritual identity. • Questioning- a term used to describe people who are in the process of exploring their sexual orientation or gender identity.
o Agender o Cisgender Woman o Cisgender Man o Gender Fluid o Gender Non-conforming o Genderqueer o Non-Binary o Trans Female or Trans Woman o Trans Male or Trans Man
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o Two-Spirit or Other Native Identity o Questioning o Prefer not to say o Other (please specify): ________________________________________________
Skip To: Q2.11 If Q2.9 = Cisgender Woman Skip To: Q2.11 If Q2.9 = Cisgender Man
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Q2.10 Please check what you believe are the five most important policy priorities affecting non-binary, transgender, intersex, and other gender diverse people in the U.S. Select up to five that are a priority.

▢ ▢ ▢ ▢ ▢ ▢ ▢ ▢ ▢at work

HIV prevention, education and treatment Better policies on gender and identity documents and other records Passing anti-bullying laws that make schools safer Transgender/gender non-conforming prisoner’s rights Immigration policy reform (such as asylum or partner recognition) Allowing transgender/gender non-conforming people to serve in the military Access to transgender-sensitive health care Getting transgender-related health care covered by insurance Protecting trans/gender non-conforming people from discrimination in hiring and

▢housing Protecting transgender/gender non-conforming people from discrimination in

Including “intersex” or “X” as a legal gender marker option

▢ Passing laws that address hate crimes against transgender/gender non-
conforming people

▢adoption The right of transgender/gender non-conforming people to parent, including

▢ ▢needs

The right to equal recognition of marriages involving transgender partners Reproductive healthcare policies that support non-traditional family reproduction

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OTHER Q2.12 Do you have any physical disabilities? Any limitation on a person's physical functioning, mobility, dexterity or stamina is counted. This includes cerebral palsy (CP), epilepsy, any cancer, Alzheimer’s, cystic fibrosis (CF), multiple sclerosis (MS), Spina bifida (SB), muscular dystrophy, sickle cell disease, Tourette syndrome, Prader-Willi syndrome (PWS), brain injury, spinal cord injury, chronic pain, any visual impairment, any hearing loss, and any mobility impairment. 
o Yes o No o Prefer not to say
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Q2.13 Do you have any diagnosed neurodivergence? Select all that apply.

Alcohol or substance abuse disorder, alcoholism, or drug addiction

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Disorder (ADD)

▢ Anxiety

▢ Autism

Bipolar disorder

Borderline Personality Disorder (BPD)

▢ Depression

Eating Disorder

Obsessive-Compulsive Disorder (OCD)

Panic Disorder

Post-Traumatic Stress Disorder (PTSD)


▢ Other (please specify):

Prefer Not to Say

▢ No

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Q2.14 Were you born in the US?
o Yes o No
Skip To: Q2.16 If Q2.14 = Yes
Q2.15 If no, what age did you come to the US? ________________________________________________________________
Q2.16 What language do you speak most often?
o Arabic o ASL o English o Hindi o Language originated in China (Mandarin, Cantonese, etc.) o Spanish o Other (please specify): ________________________________________________
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ShoutOut Austin! LGBTQIA+ Quality of Life Study