AZTYPO - Zak Ricci Memorial Mutual Aid Application

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This form gathers the required information for an applicant to take advantage of the mutual aid grant available through AZTYPO. You must be an Arizona resident to receive the funds. The funds must go to support a trans or gender expansive youth up 24 years of age.

By submitting this form you are agreeing to the above terms of the grant.

Please complete the application below and submit the form. Please allow up to a week for us to reach out. Your request will be reviewed by our board members so please be detailed in your answers.

If you are selected to receive the grant, the funds will be sent via Pay-Pal.

First and Last name of the person who will be receiving the funds *

Pronouns *

I am an Arizona resident? *

Yes

Phone number or email to send the funds to. *

These funds will be used to support a trans youth up to the age of 24. *

Yes

We do not expect you to provide proof of the expenses you request the grant for. We do ask that you commit that the funds will be used in support of a transgender gender expansive youth under 24 in some way.

I agree and commit to using funds in this manner

I do not agree to using funds in this manner (please note if you do not agree, you will not receive a grant)

Brief description of what the funds will be used for: *

Email *

Phone number (if we need to reach you for questions) *

Amount you are requesting. *

Submit

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