Solidarity Fund Application Form (Summer 2017)
This is the application form for the Summer 2017 Action for Trans Health solidarity fund which is open to applications from all trans, nonbinary and gender non-conforming people living in the UK. Part of this funding round will be ringfenced for trans people of colour (ie. from African, Caribbean, Asian and Arab descent, including people of mixed raced backgrounds and other racialised people).

Throughout the year, we raise money to help trans people who for whatever reason cannot access healthcare through the NHS in a reasonable amount of time. We know that the trans healthcare system is pretty broken, and that the people who need support will usually outweigh our ability to fundraise. Because of this, we use this application form to work out who faces the most barriers to getting healthcare through the regular ways. .

Action for Trans Health takes a broad view of health. We know there are a wide number of things that can effect your healthcare, and so we don't have any rules about what the money can be used for. We do ask that if the money is being used to access medication which will be needed long-term, that the applicant has thought about how to secure the long-term supply after the grant money has been spent.

Please note that we tend to give out small grants. The average grant is typically between £200 and £400. The largest grant we have given away previously has been £1500.

Once completed forms have been sent to us, a member of Action for Trans Health's staff will anonymise the form by removing any information that could be identifying. Then this will be passed onto our funding panel who will decide where the funds go. We will contact you to let you know whether you have been given any money within two weeks of the funding panel meeting.

The deadline for this funding round is 17th August 2017.

Your contacts
This section will only be seen by the Action for Trans Health staff and will not be passed on to the funding panel who decides where the funds go.
Name *
Your answer
Age *
Your answer
Phone Contact *
Your answer
Email *
Your answer
Preferred contacts *
Place of residence
City / Town / Village you live in.
Your answer
Do you want your email to be added to the Action for Trans Health Mailing list?
This data will be used for equality monitoring purposes and to identify what barriers you might face to accessing treatment through the NHS or other means.
Do you define as trans or intersex?
tick any that apply
How do you define your gender?
Your answer
Do you consider yourself to be affected by transmisogyny?
ie. are you are a trans woman or a non-binary person who was assigned male or intersex at birth
How do you define your race and/or ethnicity?
Your answer
How do you define your nationality?
Your answer
Do you face any barriers to accessing healthcare because of your nationality or citizenship status?
Your answer
How do you define your sexuality and/or romantic attraction?
Your answer
How do you define your class background?
Your answer
Do you define as disabled?
Please discuss any access needs you have that may impact on your access to healthcare
By this we mean any aspects of yourself or your environment that make it harder for you to get healthcare: for example if you don't speak fluent English or cannot use public transport due to a disability/mental health problem. If you are disabled and have a carer/personal assistant it would be useful to know how supportive they are and whether you are dependant on them for your healthcare.
Your answer
Do you have a religion / come from a religious background? (Please state)
ie. Christian background, practising Muslim, etc.
Your answer
Do you have any dependants or caring responsibilities? (please describe)
Your answer
What is your housing situation? (please describe)
ie. living with a partner, no longer living with or in contact with family, vulnerably housed / homeless, etc.
Your answer
Tell us a bit about yourself *
Your answer
How much money are you applying for? *
Please let us know if there is a smaller amount that would also be useful to you. Remember that our grants tend to be small, the biggest grant we have ever given to one individual was £1500.
Your answer
Have you applied to the solidarity fund before? *
What do you plan on using the money for? *
Be as specific as you can. We take a broad view of healthcare and so are willing to consider funding a wide range of things.
Your answer
What barriers have you faced when trying to get healthcare you need through other means? *
We are interested in hearing how you have tried to access the service you need in the past, through what ways (ie. NHS, private, self-medication), whether you have been refused treatment or services for whatever reason, and anything else you think it appropriate here.
Your answer
Please provide a payment method, such as an email address associated with a PayPal account, or your account number and sort code
This helps us to speed up how quickly we can make payments. Please provide this only if you are comfortable doing so. We will delete this information from our records as soon as possible.
Your answer
Have you talked about anything in this application that might be upsetting to read?
Please provide us with content notes / trigger warnings if appropriate
Your answer
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