JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Pride Center Student Financial Support Application
Please complete the application below if you are seeking financial support from the Pride Center at Lehigh University.
* Indicates required question
Email
*
Record my email address with my response
Name
*
Your answer
Pronouns
Your answer
Lehigh Email
*
Your answer
LIN
*
Your answer
Please select what form of financial support you are requesting:
*
Support for gender affirming needs (HRT, binder, packer, clothing, therapy, etc)
Support for queer and/or social justice related professional development (conference attendance)
Emergency financial support (food, housing, unexpected expenses, etc.)
Other:
Required
Please briefly expand on what form of financial support you are requesting and why:
*
Your answer
How much financial support are you requesting? (some receipts may be required to submit if you are seeking reimbursement(s) and we will contact you upon completion of this form if we need anything else from you)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lehigh University.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
