2024 Twirl to the World - Twirl Assistance Program (TAP) Application

Twirl Assistance Program (TAP) Application

Review eligibility and deadline information below, complete sections 1-5, then submit application along with your electronic signature.
Eligibility: The current grant is intended for self-identified Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ) residents 18 years and older in the Charlotte metropolitan area* who are referred by our partner agencies, and who need financial assistance with groceries, medical, and/or transportation costs. All submissions will be considered based on eligibility, need, an objective selection process, previous applications, previous receipt of assistance, and availability of funds.

* The official Charlotte metropolitan area includes the Charlotte–Concord–Gastonia Metropolitan Statistical Area (MSA), which includes Cabarrus, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, and Union counties in North Carolina; Chester, Lancaster and York counties in South Carolina.

Grant Period Timeline:
- Twirl Assistance Program (TAP) is now a year-round hardship grant program
- Applications from individuals will be considered one year after previous assistance received. Example: If applicant received assistance in May, they can apply again and be considered in May or after the following calendar year.
Personal Info

Section 1 of 5
Legal Name*

First NameMiddle NameLast Name
Preferred Name
(optional and if applicable)
Preferred Pronouns?*

They/ThemShe/HerHe/HimOther
Birth Date*

MonthDayYear
Date
Current Age*
Relationship Status*
Select one
Dependants*
DO NOT include yourself
How do you self-identity?*

LesbianGayBisexualTransgenderQueerNon-BinaryOther
Which of the following best describes you?*

Asian or Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or Alaskan NativeWhite or CaucasianMultiracial or BiracialA race/ethnicity not listed herePrefer not to answerOther
Contact Info

Section 2 of 5
Email:*

Confirmation Emailexample@example.com
Preferred Phone Number*

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Referral Info

Section 3 of 5
Have you applied for and received TAP assistance before?*

YesNo
If so, when was the last time you applied?
Month and Year you applied and received assistance
IN 2023, TAP is by Referrals only. Please select Referral Name.*

Bar Argon/SidelinesCharlotte Counseling & WellnessCharlotte Gaymers NetworkCharlotte PrideCharlotte Transgender Health GroupCrisis Assistance MinistryThe Freedom Center for Social JusticeLotus Counseling GroupNorthStar Clinical ServicesRAINSamaritan HouseState of EmergencyStonewall Sports - CharlotteTime Out YouthTranscend CharlotteWinter Awakening
Who is your primary point of contact there?*
Name of contact
Are you currently employed?*

Yes, I am employed full timeYes, I am employed part timeNo, I have been unemployed or furloughed
Employer Name(s):*
Current or previous employer. If unemployed, type N/A
Have you been terminated or furloughed due to COVID-19 pandemic?

YesNo
Upload any supporting documentation of furlough or termination

Browse Files
Black out any Social Security or sensitive information. Cancelof
Are you currently receiving or in the process to receive unemployment benefits?*

YesNo
If so, upload any supporting documentation of unemployment claim made.

Browse Files
Black out any Social Security or sensitive information. Cancelof
Do you currently have any other means of income or assistance?*

YesNo
If so, please provide income or assistance details.
Do you currently have health insurance?*

YesNo
If so, please provide insurance details.
No account numbers, just type and provider and expected length of coverage
Assistance Info

Section 4 of 5
Reminder: The current grant is intended for self-identified LGBTQ residents 18 years and older in the Charlotte metropolitan area who are referred by our partner agencies and/or are impacted by the COVID-19 pandemic, and who need financial assistance with groceries, medical, and/or transportation costs. Preference will be for pre-paid/gift cards or direct payment to service provider(s).

Applicants should work directly with State Employment offices for Unemployment; Utility or telecommunication companies for assistance/payment deferrals for each of those specific services; Financial institutions for mortgages, credit cards, loans, etc.; Landlords for rentals.

(Check all that apply, and then indicate time frame and describe or provide details)
What do you need assistance with?*

GroceriesMedical (prescriptions, co-pays, etc.)Transportation (to from medical appointments, gas, public)
From the emergency assistance services we can offer, which is most important to you?*

GroceriesMedicalTransportation
Please describe or provide details of the assistance you need most and why
Describe or provide details of need for Medical Assistance, including preferred pharmacy if applicable.
Describe or provide details of need for Transportation Assistance, including either fuel/gas or public transportation.
For mental health therapy, are you an Existing patient at one of our pre-approved partners or will you be a New patient?

ExistingNew
For Existing patients, please select your pre-approved provider.

Charlotte Counseling & WellnessLotus Counseling GroupNorthStar Clinical Services
Confirmation

Section 5 of 5
Acknowledgement, Agreement, and Reminder of Confidentiality

I certify that all of the information in this Twirl Assistance Application (TAP) is true, complete and accurate and the hardship(s) identified above has/have contributed to submission of this request for hardship relief.

I understand and acknowledge that Twirl to the World hosts/members may investigate the accuracy of my statements, may require me to provide additional supporting documentation, and that knowingly submitting false information may disqualify this application.

I understand that any information or documentation I provide will be kept strictly confidential, and that only by my express permission, will Twirl to the World Foundation be allowed to share any information with partner agencies/organizations for my benefit.
Applicant Signature:*

Clear
Today's Date*
Should be Empty:

Twirl Assistance Program (TAP) Application

Personal Info

Contact Info

Referral Info

Assistance Info

Confirmation