The Trans Health Legal Fund

Thank you so much for contacting the Transgender Law Center and Repro Legal Defense Fund (RLDF).

The Trans Health Legal Fund provides resources for trans people facing investigation, arrest or prosecution for seeking healthcare. Please fill this form out to the extent that you feel comfortable.

First Name

Middle Name

Last Name

Company

Date of Birth

Country of Birth

Phone Number

Email (This form will send you a confirmation email.)

Email Type

Street Address

Your City

Your State

Zip

Address Type

What are your pronouns

What language(s) do you/your client prefer to communicate in?

Are you reaching out to us for yourself or someone else?

Are you an attorney?

YesNo

Do you/your client have an immigration attorney?

YesNo

If you are an attorney contacting us on behalf of your client, please provide your bar number(s)

Please separate bar numbers with a comma

If you are an attorney, in which state(s) are you licensed to practice law?

Select/deselect values from a multi-select picklist by holding the Crtl (Windows) or Command (Mac) key on your keyboard while clicking

City and state of investigation, arrest, or prosecution

What are the charges/allegations? (Please include the penal code sections if possible.)

Please share basic facts of the case

Please share information regarding financial need

E.g. unemployed, has multiple dependents, etc.

Please share any information that makes this request URGENT (e.g. upcoming court dates), being incarcerated, etc.

E.g. unemployed, has multiple dependents, etc.

Was bail set in this case?

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Are you requesting funding for bail?

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If you are requesting funding for attorney fees, expert witness fees, bail, or other litigation costs, please itemize them here, along with a brief description.

Do you have any additional information, questions or requests from us?

Please attach any relevant documents you want us to look at [e.g. budgets].

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