BECOME A PART OF OUR COMMUNITY

Client screening

Would you like to be added to our guest list?

Are you in School?

Race (Please Check One)

Gender Identity

Sexual Orientation

Are you currently Employed?

Do you or your family have health insurance?

Are you linked to a primary care?

Do you currently have a place to live?

If yes, where do you live?

Have you ever been tested for HIV?

What was the test result?

If HIV+, are you in care?

Do you or your family receive any of the following entitlements?

How did you hear about your services?

Check off the opportunities, program activities, or services you are interested in:

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CONTACT

DESTINATION TOMORROW
452 E 149th St 3rd floor
Bronx,N.Y. 10455
Toll Free: 833.DT.4LGBT
Tel: 646.723.3325
Fax: 917.580.6485

PROUD MEMBERS

NLGCC NEW YORK