Queer & Trans Wealth Scholarship Form

1
What's your name?* This field is required.
First and last name
2
Pronouns
Pronouns
3
What's your email address?* This field is required.We will notify you via email if you are selected for a scholarship.
4
How would you describe your gender identity?* This field is required.
Transgender
2-Spirit
Nonbinary
Agender
Intersex
Cisgender
Other
5
How would you describe your sexual orientation?* This field is required.
Queer
Gay
Lesbian
Bisexual
Asexual
Pansexual
Other
6
Do you identify as Black?* This field is required.
Yes
Biracial/multiracial
No
7
Do you identify as Indigenous?* This field is required.
Yes
Biracial/multiracial
No
8
Do you identify as a Person of Color?* This field is required.
Yes
Biracial/multiracial
No
9
What is your age?* This field is required.
10
Do you have children?* This field is required.
Yes
No
11
Are you the parent of a trans child?* This field is required.
Yes
No
12
Besides earnings from your job, do you have additional income from a partner or parent?* This field is required.
Yes
No
13
Is there anything you'd like to add about your identity?This is optional. Any information shared here could help us understand more about your needs. Queer & Trans Wealth may use this information for fundraising or marketing purposes.
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14
What state do you live in?* This field is required.If you do not live in one of the states listed below, you are not eligible for this scholarship. The states listed below have passed or introduced anti-trans legislation.
Please Select
Please Select
Texas
Florida
Montana
Idaho
Utah
Mississippi
Tennessee
Alabama
North Dakota
Kansas
Oklahoma
Louisiana
Nebraska
Iowa
Missouri
Arkansas
Indiana
Ohio
West Virginia
South Carolina
New Hampshire
Alaska
Wyoming
South Dakota
Kentucky
North Carolina
Georgia
15
Is there anything else you'd like to add about your location?This is optional. Any information shared here can help us understand more about your needs. Queer & Trans Wealth may use this information for fundraising or marketing purposes.
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Ok
16
How much money do you make per month?* This field is required.You can enter an amount before or after taxes. The next question asks if this number is before or after taxes.
The next question asks if this number is before or after taxes.
17
Is this number before or after taxes?* This field is required.
Before taxesAfter taxes
18
How much money do you pay in debt each month?* This field is required.It's okay to give an estimate.
19
Are you able to pay part of the fee?* This field is required.This is completely optional. Paying a small amount allows more people to access our services.
No
Yes, $25
Yes, $50
Yes $75
Yes, $100
20
Is there anything else you'd like to add about your financial services?This is optional. Any information shared here can help us understand more about your needs. Queer & Trans Wealth may use this information for fundraising or marketing purposes.
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Small
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Ok
21
What's your top financial concern?* This field is required.Please choose only one option. Later, you'll have a chance to specify more financial concerns.
Moving to a safe state
Saving for gender-affirming surgery
Paying off debt
Building an emergency savings fund
Becoming financially independent from partner(s) or parent(s)
Earning more money so you can meet your basic needs
Developing a healthy relationship with money
22
What's your second top financial concern?* This field is required.Please choose only one option. Later, you'll have a chance to specify more financial concerns.
Moving to a safe state
Saving for a gender-affirming surgery
Paying off debt
Building an emergency savings fund
Becoming financially independent from partner(s) or parent(s)
Earning more money so you can meet your basic needs
Developing a healthy relationship with money
23
Select all of your financial concerns.* This field is required.You may choose multiple options.
Moving to a safe state
Saving for a gender-affirming surgery
Paying off debt
Building an emergency savings fund
Becoming financially independent from partner(s) or parent(s)
Earning more money so you can meet your basic needs
Developing a healthy relationship with money
24
Is there anything else you'd like to share about your financial goals?This is optional. Any information shared here can help us understand more about your needs. Queer & Trans Wealth may use this information for fundraising or marketing purposes.
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