Gender Junk Request Form
First and Last name?
What are your pronouns?
Something different (see next question)
If you use different pronouns, what do you use?
How do you identify? (Check all that apply)
Prefer to self-define (see next question)
If you identify differently, please tell us how you identify
How old are you?
City, State Zip code
Is this your personal address?
This is a PO box
This is a friend's/ally's address
What is your phone number?
Are you out to your parents/caregivers?
Yes, I am out to both/all of my parents
Yes, but I am only out to some/one of my parents
Describe your situation to us a little bit.
What item(s) are you hoping to receive?
What is the best way for us to contact you?
If you listed "social media" as the best way to contact you, please tell us what platform and your username (ex. Instagram @transfamilysos). If you did not choose social media, please put "n/a"
How did you find out about our Gender Junk Program?
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Trans Family Support Services.