2020 Surgery Fund Instruction Packet
This Instruction Packet will walk you through every question in our application form, so that you may have ample time to think about your responses before you begin.
It’s our goal this gives every applicant an equal opportunity to carefully prepare responses and submit a quality application.
- Be sure to review our Frequently Asked Questions before you continue with this packet.
- Only applicants that will be 18 at the time of surgery will be considered.
- The application period begins November 1 and the deadline to apply is Saturday, November 30, 2019 at 11:59pm EST. The timing of when you submit your application (beginning vs. end of the month) will not affect your likelihood to be considered for funding.
- No applications will be accepted after the deadline.
- Only one response per applicant will be reviewed. (In the event of a duplicate response, only the first application will be considered.)
- All application submissions are final. You will not be able to edit your responses.
- All applications MUST be submitted through the Google Form, which is provided at the end of this packet. Please do not submit answers via email or snail mail – they will not be reviewed.
- Please add email@example.com and firstname.lastname@example.org to your safe senders list to ensure you receive updates about your application status.
- Your Name
- Your Phone Number
- Your Pronouns
- Is your location based in the US or abroad?
US-Based Applicants Only
International Applicants Only
- Do you anticipate any issues (with visas, passports, etc) entering the US to have your surgery?
- What country is your citizenship?
- Have you considered or made arrangements for travel and lodging to and from the US? Explain.
Information About Your Surgery
The questions below regarding savings, health insurance coverage, or your preferred surgeon will not impact your likelihood to receive funding. We ask these questions in case we are able to connect you with other resources and opportunities. Please answer as honestly as you can.
- What surgery/surgeries are you applying for assistance for?
- How much do you have saved for your surgery (in USD)?
- Have you received an estimate or quote for your surgery?
- Do you have health insurance?
- If yes, what provider do you have?
- Please list your preferred surgeon(s), if applicable.
- Would you consider a different qualified surgeon?
The demographic info collected in this section helps us identify additional grant and partnership opportunities, and better serve our applicants and community in the future. Your responses will not affect your eligibility for this (or any other) Point of Pride program. It is for statistical use only.
- What is your ethnicity origin?
- What is your gender identity?
- Veteran/Military Status
- Do you have any long-standing illness, disability or infirmity? (Long-standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time.)
- Are you currently, or have you ever experienced homelessness or housing insecurity.
- Are you currently, or have you ever experienced discrimination by your health care provider?
Short Answer Responses
In the last section of the application, you will complete four short answer responses. These questions are highlighted below. Please read the notes and explanation beneath each question, so you understand what our reviewers are looking for.
Please note: This is not an English test. We will NOT consider grammar/spelling or writing ability when reviewing your responses. We just ask you to be as specific, detailed, and complete as you are able to be within the character limits.
- Describe your current financial situation. (800 character limit)
This question impacts our decision-making process more than any other response. We ask this question to understand the expenses and circumstances that have created your financial need, as well as the lack of access to outside financial resources. Examples of what you can discuss here are:
- your employment situation, or if you’re unemployed
- your housing situation, or if you’re living with housing insecurity/homelessness
- if you are the main financial provider for others, and what that looks like
- If you have other medical or financial concerns outside of your transition
- if you are a student
- if you’ve experienced unique or extreme circumstances in your life that have impacted your savings or financial ability to afford care
- Describe all attempts you have made before to afford gender-affirming care, including savings, fundraising, or insurance. (800 character limit)
We ask this question to understand what steps you have taken in your health care journey and that you fully understand the financial roadblocks unique to your situation. Examples of what you can discuss here are:
- research you’ve taken towards your procedure type, recovery, preferred surgeons, etc.
- research or action you’ve taken towards obtaining health insurance, seeking insurance coverage, appealing an insurance denial, seeking CareCredit or financing, etc.
- financial decisions you’ve made to attempt to fundraise for care, such as creating a surgery savings account, taking on a second job, hosting a fundraiser, etc.
- Describe your support system. Tell us about the people in your life who you lean on for support. (800 character limit)
Who are the close, affirming family or friends who will be there for you during and after surgery? We ask this question to understand your living environment and support network, and understand whether your environment is stable to assist in your recovery. You can tell us about how they have supported or intend to support you in the future, and what they mean to you.
- Tell us something else about yourself. (800 character limit)
Each of us is so much more than just our trans identity. We ask this question because we want to have a better understanding of who you are as a person. What makes you, you? Examples of what you can discuss here are:
- your goals and dreams for the future
- activities or things you’re passionate about
- lived experiences that have shaped the person you are today
Click the link below to access the application form:
Reminder: the form deadline is Saturday, November 30, 2019 at 11:59PM EST.
Absolutely no applications will be accepted after this time.