Trans Maryland Document Assistance Network Clinic Request Form

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Use this form to request a queer and trans affirming Document Clinic at your community center, non-profit, place of worship, etc. Someone from our team will reach out to you to follow up on your request and work on scheduling.

Note: Regardless of the policy of the individual community partner, masks will be required at Trans Maryland Document Assistance Network Clinics. Extra masks will be provided.

Stay tuned to our website for information about additional clinics as they are added.

Your name and pronouns *

Your email address *

Name, pronouns, and contact information for event point person

Only required if this person is not you!

Proposed event location *

Proposed event date *

YYYY

Proposed event start time *

Time

Proposed event end time *

Time

Are there other dates that could work for you?

If so, please list them below

Check all that apply to your space *

This space is accessible to wheelchair users and those who use walkers and other assistive devices

This space has private areas available for 1-on-1 counseling

This space has an area available for childcare

This space has an antidiscrimination policy in place

This space is a religious space

This space is open to the public

This space requires going through security/metal detectors

Other:

Required

Our clinic volunteers can offer support around a variety of topics. Please select below which topics you are most interested in offering for your community *

Note: Topics offered are subject to availability of volunteers who are subject-matter experts. While we will try our best to match our volunteers to your needs, there is no guarantee we will be able to offer every type of requested help at your event.

Name and Gender Marker Changes

Estate Planning

Second Parent Adoption

Healthcare Planning (healthcare proxies, advance directives, living wills)

Immigration assistance

Healing/Energy Work

Required

I would like to offer childcare during clinic hours *

Yes

Other:

I have staff/colleagues/community members who can help staff the clinic *

Yes

Other:

Anything else you want us to know?

Submit

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