Application for Assistance
By submitting this application you consent that you are over the age of 18, a part of the leather/bdsm/kink/lifestyle communities and agree to sharing provided information with LHF.

Confidentiality:
Your confidentiality is important to us. The number of LHF volunteers you speak to will be limited and your information shared with LHF volunteers only on a need to know basis.

First Name *
Please enter your legal first name as it appears on your Government ID
Your answer
Last Name *
Please enter your legal last name as it appears on your Government ID
Your answer
Chosen Name
If you go by a name different than that on your government ID, please enter here
Your answer
Scene Name(s) *
Please enter the scene name you go by within our community
Your answer
Social Media Handles *
Please enter your social media accounts
Your answer
Date of Birth (must be 18 years or older) *
MM
/
DD
/
YYYY
Email Address *
Please enter a valid email address, as this will be our primary form of contact
Your answer
Phone Number
Your answer
Address *
Your answer
What is your involvement in the leather/fetish/kink community? *
Your answer
Have you ever received funding from LHF? *
If yes, when?
Your answer
Briefly describe your financial hardship and your reason for applying for funds *
Your answer
Please list below the assistance needed, including amounts. *
Your answer
Is this request housing related? *
If Yes, have you requested assistance from your local board of Social Services and what was the result of that request?
Your answer
Please check all sources of income *
Required
Please enter the amount of Monthly income(s) from above *
Your answer
By sending in this application you agree to share this information with Leather Heart Foundation for the purposes of assistance. Any information obtained will be used for only this reason. By entering your legal name, you agree to sharing this information. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Leather Heart Foundation.