Genderbands Top Surgery Grant Application
HOW TO APPLY:
Applications open November 1, 2018 - December 31, 2018
Fill out this form, only submitting once. Multiple submissions will disqualify all submissions by the applicant. If you are having technical difficulties and are unsure whether or not a submission went through, you may email us at genderbands@gmail.com to confirm we received your submission. Please only email us if you had issues submitting. Do not email us simply to confirm a submission.
We will review the information in your application to verify that you meet all of the requirements. Qualifying applicants will be entered into a randomizing software, and the winner will be selected purely by random selection.

REQUIREMENTS:
-You must be 18 years of age or older by the date of surgery.
-You must have at least 50% of the total cost of your surgery at the time of application. Genderbands will cover only a portion of the surgeon's cost. You will be responsible for raising the rest of your surgical costs prior to your surgery.
-You must have an active plan to continue raising funds (unless this grant reaches or exceeds your surgery costs).
-You must complete your surgery within the same calendar year of being awarded the grant (excluding extenuating circumstances, which will be reviewed on a case-by-case basis).
-You must complete your surgery in the United States with a U.S. based surgeon (you may live outside of the U.S. and still apply!)
-You identify as transgender or gender-nonconforming and wish to receive a bilateral mastectomy.

Grant Descriptions
Thanks to the generosity of two surgeons and people like you, we are excited to announce we are able to award FOUR grants this year!! You may select any and all grants you'd like to be considered for. Although you may request to be put in the drawing for all four grants, you can only receive ONE grant. Grants are non-transferable.

Please note that Genderbands grants do not pay for travel costs, hospital fees, anesthesia fees, time off work for recovery, or surgery reimbursement. Our grants are to help cover the cost of the surgery itself for those who have not yet been able to receive top surgery.

Below is a description of each grant.

*Genderbands General Top Surgery Grant
Recipient may choose any US based surgeon they would like.
Final amount of grant will be announced when the recipient is announced.

*Dr Geoffrey Stiller, Moscow, Idaho - Linea Cosmetic Surgery
Recipient will receive top surgery, fully covered by Dr Stiller's office.
Surgery will take place in Idaho at Linea Cosmetic
Surgery center.

*Dr Anthony Mangubat, Tukwila, Washington - La Belle Vie
Recipient will receive $2,000 off the self-paid price of $8,500 or off the recipients' insurance deductible.
Surgery will take place at La Belle Vie in Washington.
Two grants will be awarded for Dr Mangubat

Pick your Grant(s)
The winner of each grant will be selected at random from all qualifying applicants. Grant recipients will be chosen in the order listed above. If you are not selected for the first grant you selected, and if you have indicated a desire to be considered for additional grants, your application will automatically be entered in the subsequent drawing(s). Do not submit more than one application. If you submit multiple applications during the same year you will be disqualify from all grants this year.

If you are selected for a grant and can not meet the requirements to receive the award, your grant will be forfeit and given to a different applicant. You will not be considered for other grants this year. You may reapply next year, or any time after that.

For which grant(s) would you like to be considered? *
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