Eastern PA Trans Equity Project

Chosen Name*

First Last

Legal Name*

First Last

Pronouns*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Phone Number*

What type of grant are you seeking*

Amount you are requesting*

Name and address of your landlord.*

Ethnicity or Race*

Age*

Are you currently employed?*

If employed, who is your employer?

How many people reside in your household?*

What is the amount of your current monthly household income (for all members of the household)?*

What is the amount of the current monthly expenses for the household (for all members of the household)?*

Are you able to provide documentation of your income or expenses if requested (screen shots/documents)*

Are you enrolled in any of the following assistance programs?*

How did you learn about this Program?*

If you chose "Other" or "Referred by an Agency" please describe:

In 2-3 sentences, please describe your shelter, food, clothing, and health needs at this current stage of your life*

Please share any other information that will help the Committee to make a decision with regard to granting financial assistance.*

In 2-3 sentences, please share information about your life as a transgender person or the parent of a transgender child.*

Are you able to provide a copy of your lease?*

Have you ever applied for a grant from Eastern PA Trans Equity Project in the past?*

If you answered "yes," what type of grant did you apply for?

Is there any other information the Grant Committee needs to make a decision?

Would you like to receive our monthly newsletter and other updates?

Have you called 2-1-1 to seek assistance from the PA Housing Assistance Hotline?*

Are you a transgender person or the parent of a transgender child?*

Housing Grant Application