The Opal Center Assistance Fund Application

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Use this form to request aid from The Opal Center's Assistance Fund. This fund awards small grants to applicants from the LGBTQIA+ community to assist with affirming services. Please note that most grants will be $100 or less, though larger requests may be considered on a case-by-case basis.

What is your first and last name? *

Phone *

E-Mail Address *

What name and pronouns should we use when contacting you by phone or e-mail (if different depending on contact method, please indicate)?
*

Do you identify as part of the LGBTQIA+ community? *

How did you hear about our grant fund? *

What is the specific amount you are requesting (USD)? *

Please describe your financial situation and the purpose of the funds you are requesting. *

Do you have any other sources of income? *

Are you in contact with any other organizations or nonprofits that could provide financial assistance? *

If we are unable to fully fund your request, what other steps will you take to reach your goal? *

Please indicate your understanding that most grants will be $100 or less to assist as many persons as the Opal Center can. More funds can be requested but it is rare that we grant large-scale funding. *

I understand

Please indicate that you are over 18 years of age. *

I am over 18 years of age.

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