Surgery Fund Instruction Packet
This Instruction Packet will walk you through every question in our application form.
The goal of this packet is to give you the opportunity to carefully think about these questions and your responses ahead of time, so you can submit a high-quality application.
- Be sure to review our Frequently Asked Questions before you continue with this packet.
- Only applicants that will be 18 years of age or older at the time of surgery will be considered.
- The application period begins November 1 and the deadline to apply is November 30 at 11:59pm EST. The timing of when you submit your application (beginning of the month 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.
Last updated: January 2022
© 2016–2022 Point of Pride. All rights reserved.
Section 1: General Information
- Your Name
- Your Email
- Your Phone Number
- Your Pronouns
- Your Age
- Do you live in the United States 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.
Section 2: Information About Your Surgery
We ask these questions to better understand your situation, and 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?
- If yes, how much?
- If yes, when did you receive your quote?
- 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?
Section 3: Demographic Information
The optional 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, and you may decline providing some or all of this information.
- What is your ethnicity origin?
- What is your gender identity?
- What is your 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?
- Are you currently, or have you ever experienced discrimination by an employer?
Section 4: Short Answer Responses
In the last section of the application, you will complete four short answer responses. These prompts are highlighted below. Please read the explanation and examples beneath each question, so you understand what our reviewers are looking for.
To ensure a fair and unbiased review, applications are reviewed anonymously. In your written responses, please do not include your name or other personally identifying information, such as your full name, links to a personal website or GoFundMe page, links to social media pages, or anything else that could be used to determine who you are.
Note: This is not an English test. We will NOT consider grammar/spelling or writing ability when reviewing your responses. Above all, please give us detailed, thorough responses so we understand your unique situation.
- 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 your lack of access to outside support. Examples of what you can discuss here are:
- your employment situation, or if you’re unemployed/underemployed
- 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/debt outside of your transition
- if you are a student
- if you’ve experienced unique or extreme circumstances in your life that have impacted your existing savings or ability to save in the future
- 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 healthcare journey, and that you fully understand the financial roadblocks unique to your situation and have exhausted different potential solutions to overcome them. Examples of what you can discuss here are:
- research or action you’ve taken regarding health insurance and/or financing, such as
- obtaining insurance or changing insurance providers
- appealing an insurance denial for surgery
- seeking CareCredit or financing for surgery
- financial decisions you’ve made to attempt to fundraise for care, such as
- creating a surgery-specific savings account
- taking on an additional job
- hosting a fundraiser, GoFundme, etc.
- Describe your preparations for surgery: any research you have done, any consultations you have had, and/or how you selected your preferred surgeon (if applicable).
(800 character limit)
We ask this question to assess how far along you are in your health care journey and how well you understand everything surgery will entail. Examples of what you can discuss here are:
- research or action you’ve taken to prepare for your surgery, such as
- pre-op considerations; your type of procedure(s), your employment situation if applicable, plans for family members you currently provide for, etc.
- post-op recovery considerations, such as staying with family, chosen family, friends, neighbors, hired personnel/staff, and other caregivers
- selecting a preferred surgeon or seeking consultations, such as consultations you've had or will have, downpayments towards care, etc.
- if traveling for surgery: your plans for lodging, transportation, and the caregivers that might accompany 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. Without sharing identifying information, tell us: 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
- community groups or networks you may be a part of
- lived experiences that have shaped the person you are today
Click the link below to access the application form:
Reminder: the deadline to apply is November 30 at 11:59PM EST.
Absolutely no applications will be accepted after this time.