Surgery Fund Community Grantmaking Fellows – Interest Form
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Email address
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Your email
Full Name (First & Last)
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Your answer
Phone Number
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Your answer
How do you identify?
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Agender
Androgynous
Bigender
Demifemale/Demigirl
Demimale/Demiboy
Gender Fluid/ Gender Queer
Intersex
Non-Binary (NB; Enby)
Questioning/ Unsure
Trans Female (MtF; Male to Female; AMAB)
Trans Male (FtM; Female to Male; AFAB)
Two-Spirit
Other:
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What pronouns should we use?
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He/Him/His
Hy/Hym/Hys
She/Her/Hers
They/Them/Theirs
Xe/Xem/Xyr
Ze/Hir
None
Other:
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Age
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Your answer
City
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Your answer
State/Province
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Your answer
Zipcode/Postal Code
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Your answer
Country
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Your answer
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