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The application period begins at midnight EST on March 30th, 2021 and runs until 11:59pm EST on May 14th, 2021.

YOUR INFORMATION

INFO ABOUT YOUR SURGERY

The questions below regarding savings, health insurance coverage, or your preferred surgeon will not impact your likelihood to receive funding. We ask these questions in case we are able to connect you with other resources and opportunities. Please answer as honestly as you can.

DEMOGRAPHIC INFO

The demographic info collected in this section helps us identify additional grant and partnership opportunities, and better serve our applicants and community in the future. Your responses will not affect your eligibility. It is for statistical use only.

SHORT ANSWER 1

  • Your employment situation, or if you’re unemployed·        
  • Your housing situation, or if you’re living with housing insecurity/homelessness·        
  • If you are the main financial provider for others, and what that looks like·        
  • If you have other medical or financial concerns outside of your transition·        
  • If you are a student
  • If you’ve experienced unique or extreme circumstances in your life that have   
  • Impacted your savings or financial ability to afford care
  • Your support system for after your surgery
  • Any gap needs you may encounter

SHORT ANSWER 2

  • Research you’ve taken towards your procedure(s), such as pre-op considerations, post-op recovery considerations, preferred surgeons.
  • Research or action you’ve taken regarding health insurance, such as: obtaining insurance or changing insurance providers, appealing an insurance denial, seeking CareCredit or financing
  • Financial decisions you’ve made to attempt to fundraise for care, such as: creating a surgery savings account, taking on an additional job, hosting a fundraiser, GoFundme, T-shirt, other organizations you have partnered with. sales etc.

SHORT ANSWER 3

SHORT ANSWER 4

  • Your goals and dreams for the future
  • Activities or things you’re passionate about
  • Community groups or networks you may be a part of
  • Lived experiences that have shaped the person you are today

SUBMIT YOUR APPLICATION

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