TEP Assistance Application
Trans Empowerment Project-National will provide items needed by the trans community to the best of our ability. Items must be picked up by the applicant, unless otherwise agreed upon (shipping/delivery available for certain products). Please fill out the form below if you are having an emergency need, and you will be contacted by one of our board members within 48 hours. Please bear in mind, your completion of this form is not a guarantee that we will be able to fulfill your request, however we will do what we can to assist you. At this time, we are not able to fulfill requests for packers or STPS. (Donations are always welcome!)
Legal name (First, Last) *
Your answer
Chosen name (if different)
Your answer
Pronouns *
Your answer
What is your gender identity? *
Birth Date *
*Please use the following format: MM/DD/YYYY
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Phone number *
Your answer
Email *
Your answer
Is this an emergency? *
Are you filling out this application for yourself or someone else? (If you are filling this out for someone else, you may answer the rest of the questions accordingly.) *
Are you a United States Military Veteran? *
What is your living situation *
Which type of resources/assistance are you requesting? (Please check all that apply) *
*Some Requests May Take Up To 30 days to process. We do not give out financial assistance directly to clients. At this time TEP is not providing assistance for Packers or STP's. While we always do our best to help those in need, we can not always guarantee that everyone who applies for assistance will receive that assistance as our own resources are limited.
Required
If you indicated above, that you are seeking legal assistance, please provide an overview of your situation.
Your answer
Date of incarceration: (Please list expected date if not yet incarcerated.)
MM
/
DD
/
YYYY
Date of release: (Please list expected date if still incarcerated.)
Your answer
Please provide a summary of your current need. *
*Please breakdown your list of specific needs. Ex: if toiletries needed, please indicate which ones like shampoo, toilet paper, toothpaste, etc.
Your answer
Please provide any additional information that will help us understand the type of assistance you are requesting:. *
*Ex. clothing sizes/styles/colors, type of medical provider needed, background to your legal situation, etc.
Your answer
How soon will you need this assistance? *
*There is no guarantee for assistance once the application has been submitted. Even after being accepted into our program, assistance may take up to 30 days as all assistance is based on volunteer capacity, current funds, and approval which is decided on a case-by-case basis. However, we will do our best to accommodate urgent requests quickly.
Have you ever received assistance from us before? *
*TEP offers direct assistance such as clothing, food, hrt, binder, etc on a yearly basis. Each client may complete an application any time assistance for referrals, resources, or information is needed.
If you answered yes to the previous question, please give us a brief summary of the assistance you've received from us in the past; including when (month/year).
Your answer
Preferred Contact Method *
Please Indicate Whether You Agree To The Terms & Conditions: *
*Terms & Conditions: Some Assistance Requests May Take Up To 30 days to process. We do not give out financial assistance directly to clients. TEP offers some direct assistance through our inTRANSition program such as clothing, food, hrt, binder, etc on a yearly basis. Each client may complete an application for assistance anytime for referrals, resources, or information as needed. There is no guarantee for acceptance. Assistance is based on volunteer capacity, current funds, and approved on a case-by-case basis. Participation in this program or any program of Trans Empowerment Project is completely voluntary. TEP is not responsible for anything that occurs based on the resources or information given by our volunteers, members, and staff. Assistance from this organization is designed to empower our clients by providing multiple options to help them achieve success, any actions taken by the client will be done so by the client and therefore the results are the responsibility of the client.
Please Sign Your Full Name: *
*By signing this document you are indicating all the above information is true & correct; and approve this application for submission for the intake process. By signing this document, you are agreeing the the above situation you have described is an honest account of your needs and agree that if you misrepresent your situation or needs, you will be responsible for reimbursing TEP for any and all assistance received. If you are signing this on behalf of someone else, as a third party representative, please sign both your name and the applicant's name. (Chosen name is acceptable)
Your answer
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