Provider Index/Registration

As we gear up for the events of the 2011 Communi-T: Portland’s Trans Resource Fair, we’ve taken a moment to stop and think about what we really value as a part of the fair. We are at a loss for words to describe how much we appreciate our incredible range of high-quality providers!

There are exciting new developments happening at Communi-T: Portland’s Trans Resource Fair. One one the developments is the creation of a provider index. The Communi-T Index will be used for several purposes. Primarily, it will serve as a tool for community members to find the most appropriate and highest quality providers. It will also serve as a gauge for you to understand what we in the trans community look for in a provider. One aspect of our providers that we find to be most appealing is their desire to constantly improve their services and their ability to make those services available to the trans community.

Below you will find a questionnaire that will allow the Communi-T committee to create the index. Please note that only providers who have completed an index questionnaire will be considered for tabling and advertisement at Communi-T. Your answers to these questions will be held in confidence by the Communi-T committee for the purposes of compiling the index only.

*For the purposes of the Communi-T Index questionnaire, the term “fluent” means that you exhibit more than simple knowledge about an identity and are able to interact and provide your services in a manner that maintains respect, ease, and comfort with your client.

Name:

Email:

I: Your office environment:

1. Please upload a copy of any intake forms (if applicable).

2. Are your office staff/coworkers trans fluent*?
 No Some All

3. Does your office provide training for your office staff/coworkers on trans identities?)
 Yes No

4. Do you advertise as being trans/queer fluent? Is your office/building clearly marked as a safe space?
 Yes, both No, neither or only only one

5. How are your bathrooms and/or changing rooms marked?
 Men’s and Women’s/Gendered Gender Neutral/Unisex/Nongendered

II: Your experience:
1. How many years have you been working with the trans community?

2. Please describe where you have learned about trans issues and care.

3. Please list any continuing education you have received that focused on marginalized identities.

4. Please describe your involvement in the trans community.

5. Please indicate any other identities you are fluent in (check all that apply):
 Queer/LGB Kink/BDSM Poly/Open Relationships Communities of Color
 Deaf and Hard-of-Hearing

IIIa: Your philosophy on care (for providers of medical and mental health services):
1. How do you use the DSM/WPATH?
 For determining client care  As a starting point in the approach to care, but I don’t gate-keep As a bookend

2. Do you offer a slding-scale for trans clients?
 Yes No
If yes, up to % off my standard rate

3. How do you view the insurance system’s stance on trans identities?
  It meets the needs of my clients   It limits the care my clients can receive, but it is what it is  It limits the care my clients can receive, but I can be creative in helping meet my clients' needs

IIIb: Your philosophy on care (for providers of consumer services):
1. Please list/describe all workshops and/or classes you offer that are specific to the transgender community.

IV: Your identity
1. Do you self-identify on the Queer/LGB spectrum?
 Yes No

2. Do you self-identify on the Transgender spectrum?
 Yes No

V: Please also submit (this information will be included in the Communi-T Resource Guide):
1. Your contact information

Address:

Phone:

Other:

2. Your biography

3. A description of the services you provide