Faces of Pride Registration

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Faces of Pride Registration

Please complete this form to be featured in the June 2021 Faces of Pride Campaign and demonstrate your support for Brockport LGBTQIA+ students, faculty, and staff.

Name Name * First Last
Email *
Please tell us your pronouns (ex: she/her, he/him, they/them, zi/zir) *
What is your role on campus?

Student (please share year and major)
Alum (please share your class year and major)
Staff (please provide your office)
Faculty (please provide your academic area)
Brockport community member *
I identify as: *

I identify as: A Member of the LGBTQIA+ Community An Ally of the LGBTQIA+ Community Prefer Not to Say
Please complete this prompt:

I support LGBTQIA+ Golden Eagles by... *
Maximum of 250 characters allowed. Currently Entered: 0 characters.
Please upload a picture of you so we can feature you! *

Attach Files
I consent to have information, including my photograph, shared by SUNY Brockport and its individual offices as part of the Faces of Pride Campaign. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

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