Broadway Gatlyn Spectrum Grant

The Broadway Gatlyn Spectrum Grant

Background
Medical transition is not just a desire for several transgender individuals, it is also a necessary step for individuals to feel whole; to feel like their authentic self. Gender affirmation surgeries are continuing to be a tough subject when it comes to health insurance and medical necessity. While some companies and insurance carriers do cover medical expenses associated with transitioning, an overwhelming majority don’t. This leaves transgender individuals with an overwhelming task of funding their surgeries themselves. For a lot of transgender individuals, this can be next to impossible. Through the efforts of the Imperial Court of Arizona; we want to make it possible for transgender individuals to become their authentic self but alleviating the burden of the costs associated with gender affirmation surgery.

Applying for the Grant-
This grant was developed to assist Arizona transgender individuals with gender affirmation surgeries. This grant will award one individual up to $5000 towards their gender affirmation surgery. The recipient will show a financial need, their active diligence in following the WPATH standards of care, active involvement in raising the needed money, active participation in organizing/scheduling their medical transition, and show active involvement in their community.

· Be a United States citizen or permanent resident of the United States and resident of the State of Arizona for the past 365 days. (If permanent resident, please attach a copy of your residency card). MUST BE 18 YEARS OLD OR OLDER.

· Have a surgeon picked out and either a consultation scheduled or your plans to schedule this. Have surgery letters by physician and/or licensed therapist.

o If applicant has not completed all of these steps, but is planning to do so, please include your plans in your application.

· Identify who will care for and provide support post-surgery.

· Applicant must demonstrate a need for financial assistance.

· Applicant must detail the efforts they have made to fund-raise and the amount of cost that they will be able to cover on their own, if any.

· Applicant must show evidence of community involvement (i.e. school, church, civic, LGBT,etc.)

· The payment will be made directly to the doctor or hospital facility. You must comply with any and all requirements according to the Standards of Care of the World Professional Association for Transgender Health’s (WPATH) as determined by your selected surgeon.

Decision Making:

A panel of representatives from the community will be deciding on the recipient. We look at readiness, preparedness, financial means, community involvement, your story and how this will help as well as how you would further assist the grant in growing. It is not an easy decision to make and we encourage you to also look at several other opportunities as well for financial assistance. We can only choose one per year, and you can apply every year! Thank you for applying and being part of this amazing grant and organization.

Read and Understand*

Yes, I have

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

Full Name*

First NameLast Name

Birthdate:*

MonthDayYear

Mobile No. :*

Area CodePhone Number

E-mail :*

Where the confirmation will be send to

Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Gender:*

Enter Gender Identity*

Are you a US citizen?*

YesNo

Are you an Arizona Resident?*

YesNo

Race? (Choose one or more):*

Ethnicity: *

Do you have a surgeon picked out?*

YesNo

If yes, who is it and if no, why not?

My Surgeon/Why I don't have one picked out yet: *

Do you have a surgery date?*

YesNo

If yes, when is it?:

Do you have a surgery letter from a clinician?*

YesNo

If no, do you have plans to get it? Explain in detail:

Have you had a consultation?*

YesNo

If no, what are your plans to complete this in detail?

Who will care for you post surgery? What are your post surgery plans?: *

Why do you need this financial help? Explain circumstances in detail: *

What have you done thus far to raise/save money towards surgery? Explain in detail: *

What communities are you apart of? Fundraise? Volunteer? (What drives you and motivates you): *

Why do you think we should choose you as this years recipient? Tell us about your journey and your story! Don't be shy - give us details on what this means to you and what you would do if you were the recipient. Personal Statement of 500-1000 words.*

As a recipient of the Broadway Gatlyn Spectrum Grant, do you agree to helping with at least one fundraiser as well as awareness for the grant?*

YesNo

As a recipient of the Broadway Gatlyn Spectrum Grant, do you agree to be present at the Imperial Court of Arizona Coronation the weekend of May 5th 2023-May 7th 2023?*

YesNo

Are you willing to be part of media, publications, etc? (Not a requirement and is not part of determination)

YesNoOther

By signing in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

E-Signature:*

The Broadway Gatlyn Spectrum Grant Application Form - 2025 Application

I. Personal Data:

VIII. Applicant's E-Signature