Ineligible Applicant Feedback Form

We're sorry that you're not currently eligible to apply to the Thrive Fund.

As this is a pilot program, it is likely that the application criteria will evolve over the next several cycles. Your feedback is invaluable in helping us refine and expand the program to better serve the community's needs.

Thank you for taking the time to share your thoughts with us.

Name (as you prefer to be called by the Point of Pride team)*

First NameLast Name

Email

example@example.com

Why were your ineligible to apply?*

I live outside the United StatesI need financial aid towards transportation, housing, or emergency needsI need financial aid towards a healthcare expense that is not specifically gender-affirming

Where do you live?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What category does your need fall under?*

Travel or lodging expenses to receive care in another state or countryPermanent relocation to a state or country where care is legal or more accessibleBasic living expenses such as rent, utilities, clothing, and groceriesCrisis or emergency fundingOther

Please share some details about your healthcare needs and the estimated amount of money you expect to need in order to access your care.*

0/800

Do you consent to a follow-up email if our team wanted to get more information about your experience or situation?*

Yes, you may contact me for follow-upNo, you may not contact me for follow-up