Spectrum Behavioral Health Microgrants
This program is for 2SLGBTQIA+ folks in Eastern Washington who are experiencing a financial barrier to accessing behavioral health services. After filling out this form one of our staff members will contact you directly to discuss your application and program eligibility. 
Email *
Do you identify as having a physical or mental disability? *
What is your first and last name? (Please provide chosen name, does not need to be your government name) *
What pronouns do you use? *
How old are you? *
Do you identify as a member of the 2SLGBTQIA+ community? *
What is your sexual orientation?
What is your gender identity?
We know that gender is complex, and that a multiple choice list is very restrictive. We have made this a fill in the blank response to provide space for those complexities. Please feel free to share as much as or as little as you would like regarding your gender identity.
Your answer

How would you describe your race and ethnicity? *
Email *
Phone number *
Zip code *
Do you prefer to be contacted by text or by email? *
Are there any safety or privacy considerations you would like us to be aware about when it comes time to contact you? 
 *
How much are you applying for? *
What services would the microgrant be used for? (Note: You do not need to specify what behavioral health issues you are looking to address, just which services you feel would benefit you in accessing care.) *
What barriers to accessing behavioral health services are you experiencing? In what ways are you hoping a microgrant might help with those barriers? *
Would you like to learn more about Spectrum's support groups? *
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