Application for Assistance
If you are in need of assistance, please complete the following form and you will be contacted by one of our team members. Please bear in mind the completion of this form does not guarantee that we will be able to fulfill your request. However, we will do what we can to assist you. Thank you!
(Chosen/Preferred) First & Last Name: *
Phone Number: *
Valid Email Address: *
Pronouns: *
Required
If your correct pronouns were not listed above, what are they?
What is your relationship to the transgender community? *
Required
What is your gender identity? *
Required
What is your race/ethnicity? *
Required
Date of Birth: *
MM
/
DD
/
YYYY
Street Address: *
City & State *
Zip Code *
Would you prefer to be contacted by call or text? *
If we have to call you, is it safe to leave a voicemail? *
What day(s)/time(s) is it safe to leave a voicemail? *
Are you filling out this form for yourself? If not, are you filling it out for a minor? *
What is your living situation? *
What kind of assistance are you seeking? (Choose more than 1, if needed) *
Required
If you are seeking Food assistance, do you have any allergies or dietary restrictions?
If you are seeking Food assistance, what is your access to preparation?
Clear selection
If you are seeking help with employment, what is your employment status now? *
Have you received assistance from us in the past? *
If you answered "yes" to the last question, please specify when and what type of assistance you received. (If you have never gotten help from us before, put N/A) *
Please read these terms & conditions and agree to them below:
*Terms & Conditions: Some Assistance Requests May Take Up To 30 days to process. We do not give out financial assistance directly to clients. Trans Empowerment Project offers direct aid such as clothing, food, HRT, binder, etc. on a yearly basis. Each client may complete an application at any time if they are in need of referrals, resources, or information. There is no guarantee of assistance; aid is based on volunteer availability and current funds, and are approved on a case-by-case basis. TEP does have an employment program, Trans Employment Project, and you can join our Facebook group at facebook.com/groups/transemployment. Participation in this program or any program of TEP is entirely voluntary. TEP is not responsible for anything that occurs based on the resources, options, or information given by our volunteers, members, and staff. These are options to help empower our clients for success; any actions taken by the client is the liability/responsibility of the client.
Do you understand and agree to our Terms & Conditions? *
By signing and submitting this document, you are attesting that all information contained herein is correct to the best of your knowledge and agree that the above situation you have described is an honest account of your needs. If you have misrepresented your situation or needs, you will reimburse TEP for any assistance provided. Please sign your full name below (your chosen name is acceptable). If you are signing this on behalf of someone else, please sign both your name and the applicant's name. *
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This form was created inside of Trans Empowerment Project.