Community Grantmaking Fellowship

Community Grantmaking Fellowship – Interest Form
This form is to sign up to be a volunteer reviewer for any (or all) of Point of Pride's financial aid programs. This is NOT the form to sign up to receive financial aid.
Your name: (As you wish to be addressed)*

First NameLast Name
Your email:*
example@example.com
Phone Number*
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What pronouns do you use?*

He/Him/HisHy/Hym/HysShe/Her/HersThey/Them/TheirsXe/Xem/XyrZe/HirNoneWrite In my Own

Demographic Info
Demographic Info

The information collected in this section helps us ensure that our reviewer pool is representative of the communities that we serve. Age and gender are required - You may skip any of the other questions that do not directly relate to CGF program requirements.
Your gender identity:*

AgenderAndrogynousBigenderCisgenderDemifemale/DemigirlDemimale/DemiboyGender Fluid/ Gender Queer/ GenderfluxGender Non-Conforming (GNC)IntersexNon-Binary (NB; Enby)Questioning/UnsureTrans Female (MtF; Male to Female; AMAB)Trans Male (FtM; Female to Male; AFAB)TransfeminineTransmasculineTwo-SpiritWrite In my Own
Your age:*
Thank you for your interest. Unfortunately, at this time, the CGF program requires that reviewers be at least 21 years old. To learn about other volunteer opportunites, please check out https://www.pointofpride.org/volunteer
Your ethnicity origin:

Aboriginal; Indigenous; Native; Native American/First NationsAsian; Pacific Islander; South-East Asian; IndianBlack or African AmericanHispanic or LatinxMiddle EasternWhitePrefer not to discloseWrite In my Own
Your veteran/military status:

I am a US military veteranI am an active-duty US service memberI am not a member of the US militaryMy parent/guardian is a US military veteranMy parent/guardian is an active-duty US service memberMy partner/spouse is an active-duty US service memberPrefer not to disclose
Do you have any long-standing illness, disability, or infirmity? (Long-standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time.)

YesNoPrefer not to disclose
Have you applied for, or do you currently receive, government disability benefits (SSI/SSDI or your country's equivalent?)

I receive government disability benefitsI've applied for government disability and am awaiting official determinationI've applied for government disability and my benefits were deniedI have chosen not to apply for government disability benefitsPrefer not to disclose
Are you the primary caretaker for another individual?

Yes - A minor child or childrenYes - A disabled parent or older adultYes - A disabled partner or spouseNoPrefer not to disclose

How Would You Like to Volunteer?
What program(s) are you interested in reviewing applications for? (Check any/all that apply)

HRT Access FundSurgery FundElectrolysisThrive Program
Are you interested in learning about in person volunteer events (not related to reviewing applications) near the location listed above?

YesNo

Conflict of Interest & Policies
I identify as transgender or gender non-conforming. / I am not cisgender.*

YesNo
Tell us about your connection with the trans community.
Describe how you practice allyship/advocacy for the trans community.
Have you in the past, or do you plan to in the future, request assistance from Point of Pride through any of the following financial aid programs: (Check Any/All that Apply)*

COVID-19 Relief FundElectrolysis FundHRT Access FundSurgery FundThrive FundNone of the Above
Please explain in as much detail as possible so we can determine if there is a possible conflict of interest:
Please include dates applied, result of your application(s), etc. Please include all relevant details for us to make a determination about whether or not there is a conflict of interest.
Conflict of Interest Policy

Keeping our processes transparent and fair is of paramount importance to Point of Pride’s work in serving the trans community. This policy helps us identify potential conflicts of interest, which includes:
- If you are an applicant. If you apply for support through the Annual Trans Surgery Fund, Electrolysis Support Program and/or the HRT Access Fund, you may not serve as a Community Grantmaking Fellow for the cycle(s) in which you apply.
- If someone you know has applied. Please notify us below, or via email at the time you learn that they've applied. Our Board of Directors may ask some follow-up questions to ensure you will not review anyone that you may know personally to avoid giving an advantage or disadvantage to any applicant.
Disclosure of Actual or Potential Conflicts of Interest:
Volunteer Acknowledgement
If you're having trouble checking off the acknowledgement, click into the text box above and scroll through the contents to ensure you've read the entire acknowledgement, then retry the checkbox.
Confidentiality Policy

Confidentiality is of paramount importance to Point of Pride’s work in serving the trans community.

Applicant information shall be kept strictly confidential. All applicants’ identifying personal information is hidden from Community Grantmaking Fellows during the review process, but it is possible that applicants disclose information (including their name, gender identity, contact information, location, disability/veteran status, and medical history) through their written responses. All applicant information is to be kept confidential and shared only with the Point of Pride Board of Directors or Staff as it relates to our programs and services.

Any such Community Grantmaking Fellow that divulges confidential or privileged information, whether during or after their term of service, is subject to appropriate discipline, including dismissal, or other criminal sanctions.

Breaches of confidential information are subject to disciplinary action up to and including immediate termination and/or removal.
Volunteer Acknowledgement
Should be Empty:

	Yes - Currently	Yes - In the Past	No - Never	Prefer not to disclose
homelessness or housing insecurity?
discrimination by your healthcare provider?
discrimination by an employer?
incarceration?

Community Grantmaking Fellowship – Interest Form

Demographic Info

Volunteer Acknowledgement

Volunteer Acknowledgement