Request for Financial and Material Aid
Incarcerated Transgender and Gender Diverse Community Support Fund
Name of person in need of financial aid: *
Are you requesting funds on behalf of someone else? *
If you are requesting funds on behalf of someone else, please state your name and relationship to the person? *** Please note, any requests on behalf of someone else will need to be confirmed directly with the person in need of assistance.
Does the recipient identify as transgender or gender diverse?
Clear selection
What is the recipients gender identity? *
What is the recipients pronouns?
Is the recipient Aboriginal and/or Torres Strait Islander? *
If no, what is the recipient's cultural background?
What state or territory is the recipient located in?
Clear selection
Is the recipient currently in prison or at risk of incarceration? *
Required
If currently inside, what prison is the recipient in?
If currently inside, what is the recipients CRN/prison ID number?
What is the recipients date of birth?
MM
/
DD
/
YYYY
What financial assistance does the recipient need? - please state how the money requested will be used and approximate costs if known *
If approved, where will the funds be deposited?
Clear selection
So we can follow up your request directly, please provide your preferred contact details: *
Is there any other information you would like to provide?
Submit
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