Gender-Affirming Care Passenger Request

  • Air Travel Request for Gender-Affirming Care

  • We are a 501(c)3 nonprofit that relies on donations to support our work. Currently, we do not make a "need-based" evaluation for whether to support each person's request. However, we respectfully ask that you make an honest assessment of your financial need and not submit a travel request if paying for your travel would not create a financial hardship for you.

     

    Important Notes:

    • Beginning May 7, 2025, TSA will require all U.S. air passengers over 18 to present REAL ID-compliant identification for airline travel. If you are open to airline travel, please check that the ID you and any adult travel companions plan to travel with is REAL ID compliant before completing this form.
    • Elevated Access can support travel requests that originate up to 90 days (3 months) from today. If your travel date is more than three months in the future, please return to this form at a later date.
    • We strongly recommend downloading the Signal app for secure, end-to-end encrypted messaging. Learn more at https://signal.org/download/ or search for "Signal" on your phone's app store.

    To arrange travel, we must confirm with your healthcare provider or case worker that you have care scheduled. If your provider requires that you have travel arranged to schedule you, you may proceed with this form with your expected travel dates.

  • Have you had a flight through Elevated Access before?

  • What's it like flying on a small airplane?

  • We only provide the air transportation component of your journey and only once you have your appointment confirmed. In order to request a flight, you must already have plans or arrangements for the following.*

  • Contact Information

    We strongly recommend downloading the Signal app for secure, end-to-end encrypted messaging. Learn more at https://signal.org/download/ or search for "Signal" on your phone's app store.
  • Format: (000) 000-0000.
  • Preferred method of contact*

  • Provider Information

    Please enter information for us to contact your provider in order to confirm that you have care scheduled or that will be scheduled.
  • Format: (000) 000-0000.

  • Travel Schedule

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  • Passenger Information

    All aircraft are limited by the maximum weight that they can carry and sometimes have specific requirements on how they can be loaded. We need your accurate weight to ensure a safe seating configuration for the flight. Please limit baggage to 50 pounds or less. If you have a need to take more, please describe that in the Notes.
  • Do you need to travel with a companion?*
  • Do you (and/or your companion) have any mobility limitations or other needs that may impact your ability to travel safely with one of our volunteer pilots or may require additional support?*

  • Information for Airlines

    In some situations, we may offer to provide airline tickets. If you hope to have that option available, please complete the following information.

    Please note: Beginning May 7, 2025, TSA will require all U.S. air passengers over 18 to present REAL ID-compliant identification for airline travel. If you are open to airline travel, please check that the ID you and any adult travel companions plan to travel with is REAL ID compliant.

  • Have you confirmed that the ID Passenger 1 will be using for travel is REAL ID compliant?
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  • Have you confirmed that the ID Passenger 2 will be using for travel is REAL ID compliant?
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  • If you are traveling by airline, will you need any special services like wheelchair assistance?
  • We would like to ask if our passengers are willing to participate in a survey for the purpose of quality improvement. Do you feel comfortable and safe being contacted by Elevated Access via email after your flight?*
  • Should be Empty: