Trans'itions Fund Application
This form is for youth between the ages of 13 and 28 who are interested in financial assistance for gender affirming actions (ie. fees associated with name changes, the purchase of a binder or gaff, or other with PFLAG Hanover board approval).  Preference is given to youth who attend the PFLAG Hanover/Madison youth auxiliary group but is open to youth in Jefferson County Indiana and adjoining counties. This benefit can be applied for once a year.
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Today's Date *
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Applicant's First Name *
Applicant's Last Name *
Applicant's Age *
Applicant's County and State or Residence *
Parent/Guardian's Full Name
Contact Number *
Contact Email *
Would you prefer a text, call or email? *
Required
What are you requesting assistance for? *
What is the cost breakdown for your request? *
If your item is to be purchased online, please include the link to your item, below, as well as size/color requested.
Is this your first time ever applying for assistance from this fund? *
Have you been awarded assistance from this fund in a previous year? *
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