A Haven for Us – Community Microgrant Application

A Haven for Us – Community Microgrant Application

Thank you for your interest in the Community Microgrant Program! For this funding cycle, A Haven for Us will prioritize eligible applications from transgender/gender-diverse/non-cisgender applicants. This priority reflects our organizational mission and commitment to supporting communities disproportionately affected by systemic and financial barriers. However, all individuals who meet the eligibility requirements of the Community Microgrant Program are encouraged to apply. Applicants do not need to identify as transgender/gender-diverse/non-cisgender to be considered for funding.
Before You Begin

• Please provide only the information needed to explain your request. You do not need to share detailed or traumatic personal information.
• You will not be asked to provide documentation of your LGBTQIA+ identity. Self-identification is sufficient.
• Supporting documents are encouraged when available, but they are not required for every request.
• Submitting an application does not guarantee funding. Awards depend on eligibility, the competitive review process, and available funds.

Accessibility Statement

A Haven for Us is committed to making our Community Microgrant application accessible and equitable for all applicants. If you need an accommodation, assistance completing the application, or an alternative way to access or submit application materials, please contact us at info@ahavenforus.org. Requesting an accommodation will not affect your eligibility for funding or how your application is evaluated.

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A Moment of Reflection Before Applying...
Our Community Microgrant Program exists to help LGBTQIA+ people who face financial barriers to meeting important needs related to their health, safety, stability, education, and well-being. Because funding is limited, we ask each applicant to take a moment to consider their current circumstances and access to other forms of support.

You might reflect on whether you have access to financial savings, stable income, supportive family or community resources, insurance or other benefits, safe and stable housing, or other realistic ways to meet the need for which you are requesting funding. We also recognize that barriers related to disability, race, immigration status, employment, housing instability, discrimination, and other circumstances can affect a person’s access to resources and financial security.

Having access to some of these resources does not make you ineligible or mean that you should not apply. Rather, we ask applicants who are able to meet their needs through other available resources to consider making space for community members who may have fewer options.

If receiving this grant would make a meaningful difference in your ability to meet a need that you otherwise cannot reasonably afford, we encourage you to apply.
- Eligibility
  
  Please confirm that you meet each of the eligibility requirements below. All items are required. To be eligible for the Community Microgrant Program, you must be able to confirm each statement.
- I am at least 18 years of age.
- I self-identify as a member of the LGBTQIA+ community.
- I currently reside within the United States or one of its territories.
- I have a financial need or barrier that aligns with the purpose of the Community Microgrant Program.
- I have not received a Community Microgrant from A Haven for Us during the current calendar year.
- I am not a current A Haven for Us Board member, employee, or member of the Community Microgrant Review Committee for this funding cycle.
- I am not an immediate family member or a member of the same household as a person reviewing or approving applications for this funding cycle.
- If I previously received a Community Microgrant, I completed any reporting or compliance requirements that applied to that award.
- I have access to a Zelle, Venmo, or PayPal account which funds can be distributed to (if awarded).
- If you cannot confirm every required eligibility statement, please review the Program Guidelines or contact info@ahavenforus.org before submitting.
- Name and Contact Information
  
  This section helps us stay in contact with you and administer your application. We understand that the name listed on legal documents may not be the name you use or the name that best reflects who you are. We will always do our best to address you by the name you provide and will only request or use your legal name when necessary for administrative, payment, or compliance purposes. Your personal information will be kept private, shared only as needed for program administration, and will not be considered when evaluating your application.
- Name you would like us to use
  
  First NameMiddle NameLast Name
- Legal name
  
  First NameMiddle NameLast Name
- Pronouns
- Email address
  
  Confirmation Emailexample@example.com
- Phone number
  Please enter a valid phone number.Format: (000) 000-0000.
- Preferred contact method for notification
- Please note that email correspondence will be required if you are selected to receive a microgrant. Important information about your award will be sent in writing via email.
- Is it safe to leave a voicemail?
- Can we identify ourselves as A Haven for Us on a call or voicemail?
- If someone else answers this phone, can we leave a message with them?
- State or U.S. territory
- ZIP code
- Contact privacy or communication needs
  For example, this may include the best times to contact you or whether certain words should be avoided in messages.
- Privacy & Sensitive Information
  
  Please review how personal and sensitive information may be collected, used, and protected before continuing your application.
- Your application may include personal or sensitive information depending on the nature of your request. For example, if you are requesting assistance related to healthcare, medications, therapy, disability, gender-affirming care, housing, safety, or another personal circumstance, you may choose to provide information about those circumstances as part of your application.
  
  A Haven for Us uses information you provide to administer the Community Microgrant Program, including determining eligibility, reviewing your request, communicating with you, requesting clarification or additional information when reasonably necessary, making funding decisions, distributing awards, maintaining appropriate program records, and evaluating and improving the program.
  
  Information reasonably necessary to review and administer your application may be accessed by authorized A Haven for Us personnel and authorized Community Microgrant reviewers and may be processed by service providers acting on behalf of A Haven for Us. A Haven for Us does not sell consumer health data or use consumer health data for targeted advertising.
  
  Please share only the information reasonably necessary for us to understand your request. You do not need to provide detailed medical histories, diagnoses, traumatic experiences, or other personal information that is not necessary to explain your need.
  
  For more information about how we collect, use, and protect personal information, please review the A Haven for Us Privacy Policy available on our website. Additional rights may apply to residents of Washington and Nevada. Our Washington Consumer Health Data Privacy Policy and Nevada Consumer Health Data Privacy Policy are also available in the footer of our website at ahavenforus.org.
- Demographic Information
  
  We collect optional demographic information to better understand the communities we serve, evaluate the reach of our programs, and support internal program planning. You are not required to provide demographic information to apply for a Community Microgrant, and choosing not to provide it will not affect your eligibility, how your application is reviewed, or whether you receive funding. If you choose to provide demographic information, your responses will be used only for internal program tracking, evaluation, and planning. Optional demographic responses are not used to make funding decisions. You may choose to skip the entire demographic section or answer only the questions you are comfortable answering.
- Would you like to provide optional demographic information?
- Age range (optional)
- Gender identity (optional)
  
  Another identity
- Sexual orientation / sexuality (optional)
  
  Another orientation
- Race (optional)
  
  Another race
- Do you identify as Hispanic and/or Latinx? (optional)
- Do you identify as disabled, chronically ill, neurodivergent, and/or as having an access need? (optional)
- Housing situation (optional)
  
  Other
- Employment status (optional)
  
  Other
- Approximate annual household income before taxes (optional)
- Military or veteran status (optional)
  
  Another status
- Your Need and Expected Impact
  
  Plain language is welcome. Share only what you are comfortable sharing and what reviewers need to understand your request.
- A note about sensitive information: Some applicants may need to discuss health, disability, housing, identity, safety, or other sensitive circumstances in order to explain their request. Please provide only the information reviewers reasonably need to understand your request. You do not need to provide detailed medical records, diagnoses, traumatic experiences, or other personal information that is not necessary to explain your need. Information you provide in this section may be reviewed by authorized Community Microgrant reviewers for the purpose of evaluating your application.
- Describe the financial need or opportunity for which you are requesting support and what the funds would pay for
  Suggested length: up to 500 words
- How would receiving this grant support your safety, stability, health, education, personal growth, or overall well-being?
  Suggested length: up to 350 words
- Is there a deadline, urgency, or other context reviewers should understand?
  Suggested length: up to 150 words
- Do you identify as part of this cycle’s priority group (transgender, gender-diverse, or otherwise non-cisgender)?
- Is there anything else you would like reviewers to know about your eligibility, your needs, or how your request aligns with the mission of the program? If you identify as part of this cycle’s priority group (transgender, gender-diverse, or otherwise non-cisgender), you may choose to expand on that here. You are welcome to provide any context you feel is relevant, but you are not required to disclose more about your identity than you are comfortable sharing.
  Suggested length: up to 150 words
- Request Snapshot
  
  Tell us the amount you are requesting and the general purpose of the funds. While the total cost of the need may be greater, your request may not exceed the maximum award amount of $500. Note that funding is highly competitive and is not guaranteed. Furthermore, if a microgrant is awarded, A Haven for Us reserves the right to award less than the requested amount based on funding availability. Please note all requests in U.S. Dollars (USD).
- Amount requested
  This is the amount of money you are requesting from A Haven for Us, which may be up to $500 USD.
- Total cost of the need or opportunity
  This is the TOTAL cost of the opportunity you are requesting funding for, which may exceed the amount of your grant. For example, if you are requesting rental assistance and your monthly rent is $2,000 USD, then you should enter $2,000.
- Amount expected from another source
  For example, if you expect your health insurance to cover a portion of the expense or have received financial assistance from another nonprofit.
- Expense type(s) the grant would support
  
  Other
- Has any requested expense already been incurred?
- If yes, list the expense, amount, and date
- Vendor or service provider
- Estimated Budget
  
  Provide a reasonable estimate of how the requested funds would be used. Exact quotes are not required when unavailable. Please be aware that funds will not be dispersed until November 30, 2026 or later after all applicants are notified of decisions.
- Budget Items
- Confirm Amount requested from A Haven for Us
  This is the amount of money you are requesting from A Haven for Us, which may be up to $500 USD.
- Supporting documentation included
  
  Other
- Please remove or cover information that is not needed for review, such as Social Security numbers, full bank or card numbers, passwords, or unrelated medical details. A Haven for Us may request clarification or additional documentation when necessary.
- File Upload
  
  Cancelof
- Did anyone assist you in completing this application?
- If Yes, Name of person who assisted you:
  
  First NameLast Name
- Relationship to you:
- Applicant Certification
- Preparer/Assistant Certification
- Certifications and Signature
  
  Read each statement carefully. Every certification is required to submit an application, and incomplete submissions will not be considered for funding.
- Program Guidelines: Before completing the certifications below, please review the Community Microgrant Program Guidelines (Version 2026.1) available on our website. These Guidelines explain program eligibility, permitted and prohibited uses of funds, the review and selection process, award requirements, recipient responsibilities, and other program policies.
- Certification 1
- Certification 2
- Certification 3
- Certification 4
- Certification 5
- Certification 6
- Certification 7
- Certification 8
- Certification 9
  
  I acknowledge that information I provide through this application will be collected, used, and disclosed as described in the Community Microgrant Program Guidelines, the A Haven for Us Privacy Policy, and any applicable state Consumer Health Data Privacy Policy. I understand that information reasonably necessary to review and administer my application may be accessed by authorized A Haven for Us personnel, authorized Community Microgrant reviewers, and service providers performing functions on behalf of A Haven for Us.
- Electronic Signature Agreement: By signing below and submitting this application, I intend to electronically sign my Community Microgrant application. I understand that my electronic signature has the same legal effect as a handwritten signature and confirms my agreement with the certifications above.
- Applicant Signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Please verify that you are human
Should be Empty:

A Haven for Us – Community Microgrant Application

Eligibility

Name and Contact Information

Privacy & Sensitive Information

Demographic Information

Your Need and Expected Impact

Request Snapshot

Estimated Budget

Certifications and Signature