QLN General Assistance Fund Application

1

Preferred Name* This field is required.Please type your preferred name.

Preferred First Name

Preferred Last Name

2

Legal Name* This field is required.Please enter your legal name for financial tracking purposes. If it is the same as your preferred name, please retype it here. We will never deadname anyone; this information is only used for accurate recordkeeping.

First Name

Last Name

3

Email* This field is required.

Email

Confirm Email

4

Phone Number* This field is required.

Please enter a valid phone number.

6

What state do you live in?

7

Do you identify as LGBTQIA2+?* This field is required.

YESNO

8

Thank you for your interest. QLN's Empowerment Microgrants are reserved for individuals in the LGBTQIA2+ community.

9

Thank you for your interest. QLN's Empowerment Microgrants are currently limited to queer and trans Texans.

10

What type of support are you requesting?* This field is required.You can request up to $150 at a time, with a yearly maximum of $500 per person. If you need help with rent, please apply through the Rental Assistance Fund instead.

Everyday essentials — groceries, transportation, childcare, or other basic needs.

Bill payment — utilities, phone, internet, or other bills.

Medical or healthcare costs — prescriptions, doctor visits, or related expenses.

11

File Upload* This field is required.Please upload an image or PDF of the bill(s) you are requesting funds for.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

12

When is the bill due?If requesting for multiple bills, provide the earliest due date.

13

Have you received General Assistance Fund support from us this year?* This field is required.

YESNO

14

Please upload a document that shows you currently live in Texas.* This field is required.This can be any letter, bill, statement, or official mail with your preferred or legal name + a Texas address (we know documentation can be a barrier, so please upload whatever is easiest to show your Texas address). Please redact sensitive information such as account numbers, balances, or unrelated details—we only need your name and address to be visible while we limit our initial funding to queer & trans folx in Texas. Thank you for understanding!

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

15

Amount requested (up to $150)* This field is required.Many queer people depend on this support, so please only request the amount you urgently need.

16

Please verify that you are human* This field is required.