Emergency Assistance Covid-19 Fund: Phase 2
Through the grant provided by SisterReach, Love Doesn't Hurt is able to provide 50 Emergency Assistance Scholarships to members of the LGBTQ+ Community in Shelby County, Tennessee that have been victims or crime or have experienced previous trauma. Please answer the questions below to see if you are eligible.
Name: *
Preferred Name: *
Email *
Phone number *
Race *
Sexual Orientation *
If you choose other, how would you describe your orientation?
Gender: *
If you choose other, how would you describe your gender?
Have you been a victim of a crime? *
Have you experienced trauma? *
Briefly describe the crime or your trauma? *
Are you willing to complete intake paperwork? *
Are you willing to participate in a virtual intake to process your application? (phone, zoom, or google meet) *
Best time to contact you? *
Comments
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy