Gender Affirming Products Program - Youth 2024
This program is for folks 17 and under in Eastern Washington who need assistance accessing gender affirming health care, products, services, stabilizing housing, etc. After filling out this application one of our staff members will contact you directly to chat about what you need and how to get it to you safely.

Your information is being held in a password-protected database. Your name will not be known beyond a small team - we understand the sensitivity of this information and how important it is to keep this data secure and confidential.

Reach out to gapp@spectrumcenterspokane.org with any questions or if you need help filling out this form.
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Email *
What kind of assistance are you looking for? *
Required
What is your first and last name? *
The name provided does not need to be your government name.
What pronouns do you use? *
How old are you? *
What is your gender identity?
 *
We know that gender is complex, and that a multiple choice list is very restrictive. We have made this a fill in the blank response to provide space for those complexities. Please feel free to share as much as or as little as you would like regarding your gender identity.
How would you describe your race and ethnicity?
 *
What zip code do you live in?
 *
What is your email address?
 *
What is your cell phone number?
 *
What is your preferred contact method?
 *
Are there any safety or privacy considerations you would like us to be aware about when it comes time to contact you? 
 *
Is there any additional context you'd like to provide? If you'd like, let us know anything else you think is important to share, including any accommodation requests. 
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