Microgrant Application - Colorado Name Change Project

At the Colorado Name Change Project, we actively work to help transgender and gender diverse people live fully authentic lives by assisting individuals with their legal name changes & gender marker corrections.

If you aren’t cisgender, you are eligible and encouraged to apply for our services. However, we do have a few restrictions:

You must be a current Colorado resident;
The name change or gender marker correction must be for a non-cisgender person. However, parents can apply for funds to help with a trans/nonbinary child’s name/gender marker correction; and
You must completely fill out our application. If a field does not apply to you, you can put N/A or 0, but you can not leave a field blank. Incomplete applications will not be processed.

We encourage you to attend one of our in-person workshops across the state, but this is not required to apply for our microgrants. These workshops will explain the process behind changing your legal name and correcting your gender on government-issued identification documents.

We provide funding to offset the costs of:

Required FBI/CBI Background Checks
Court Filing Fee
Colorado Driver’s License or State ID
Colorado Birth Certificate
Passport
Immigration Documents
Tribal IDs

At this time we are unable to offer financial assistance for:

Medical needs or procedures – Please see The Jim Collins Foundation, Transformative Freedom Fund, or Point of Pride for these types of requests;
Housing;
Legal fees unrelated to legal name changes or gender marker corrections; or
Employment assistance

We do not discriminate on immigration status or disclose immigration status to any third party without your permission or a valid court order.

If for some reason, we are unable to provide you with a microgrant, please reach out to Trans Lifelines Microgrants to see if you qualify for their program.


                
 
 
        
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                                    All information in this form will be held in the strictest of confidence. No personally-identifiable information will be given to third parties without your express permission; however, data may be used in the aggregate for program improvement, grant-writing, or other similar purposes. By submitting this form, you explicitly agree to these uses.
                    
                    
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                        Applicant Information
Preferred Name*
                            
                            
                                                    
                                                    First
                                                
                            
                                                    
                                                    Middle
                                                
                            
                                                    
                                                    Last
                                                
                            
                        
Current Legal Name*
                            
                            
                                                    
                                                    First
                                                
                            
                                                    
                                                    Middle
                                                
                            
                                                    
                                                    Last
                                                
                            
                        
Transgender Identification*
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP
                                
                    
                
Phone*
Email*
                                
                                    
                                    Enter Email
                                
                                
                                    
                                    Confirm Email
                                
                                
                            
Driver's Lic. Number*
Driver's License or State-issued ID, 
Driver's Lic. State*    
                    
                        
                                        
                                        State
                                      
                    
                
Social Security Number*
Date of Birth*
                            
                            Date Format: MM slash DD slash YYYY
                        
                        
                    
                    
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                        Applicant's Work Information
Currently Employed*Yes
No
Most Recent Employer*
Work Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP Code
                                
                    
                
Work Phone*
Date Began Working Here*
                            
                            Date Format: MM slash DD slash YYYY
                        
                        
Date Stopped Working Here
                            
                            Date Format: MM slash DD slash YYYY
                        
                        Leave blank if still working here
Hours per Week*Please enter a number from 0 to 168.
Pay Rate*Please enter a number from 1 to 999999.
Amount of pay, in dollars
Pay Frequency*Annually
Monthly
Every 2 Weeks
Weekly
Other
Relationship Status*Single - Never Married
Married
Civil Partnership
Divorced
Separated
Widowed
Other Responsible Party?*yes
no
Spouse, Parent, Other Adult(s) in the Household?
Other Responsible Party / Minor's Info
Name*
                            
                            
                                                    
                                                    First
                                                
                            
                                                    
                                                    Middle
                                                
                            
                                                    
                                                    Last
                                                
                            
                        
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP
                                
                    
                
Own/Rent*
								
								Own
							

								
								Rent
							
Phone*
Date of Birth*
                            
                            Date Format: MM slash DD slash YYYY
                        
                        
Driver's Lic. Number*
Driver's Lic. State*    
                    
                        
                                        
                                        State
                                      
                    
                
Social Security Number
Currently Employed?*Yes
No
Most Recent Employer*
Work Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP Code
                                
                    
                
Work Phone*
Date Began Working Here*
                            
                            Date Format: MM slash DD slash YYYY
                        
                        
Date Stopped Working Here*
                            
                            Date Format: MM slash DD slash YYYY
                        
                        Leave blank if still working here
Hours per Week*Please enter a number from 0 to 168.
Pay Rate*Please enter a number from 1 to 999999.
Pay Frequency*Annually
Monthly
Every 2 Weeks
Weekly
Other
                    
                    
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                        Financial Information
Gross Monthly Income
Self*
Wages, salary, commissions)
Spouse / Other Household Members*
Parents*
If in the same household
Unemployment Benefits*
Maintenance / Alimony*
Other Income*
Other Income Description*
Other Income*
Other Income Description*
Total Monthly Income
Monthly Expenses
Rent / Mortgage*
Groceries*
Utilities*
Clothing*
Maintenance / Alimony / Child Support*
Medical / Dental*
Other Expenses*
Other Expenses Description*
Other Expenses*
Other Expenses Description*
Total Expenses
Assets
Cash On-Hand*
Cash you are carrying or which is stored at home, etc
Checking Account(s) Balance*
Name / Address of Bank*
Savings Account(s) Balance*
Name / Address of Bank*
Investment Balance*
Balance of your stocks, bonds, or other investments
Investment Details*
Type of Investment(s), Name/Location of Company/Corporation, etc
Value of Vehicles Owned*
The estimated combined value of autos, boats, RVs, etc
Amount Owed on Vehicle(s)*
Vehicle Info*
Year, Make, Model, License Plate #
Real Estate Owned*
Estimate of value of house(s) or other property owned
Amount Owed on Real Estate*
Total Value of Assets
Liabilities
Credit Card(s) Balance*
Other Liabilities / Obligations*
Total Liabilities
Substantiating Documentation
										
											Drop files here or 
											
										
									
Accepted file types: pdf, png, jpg.
								
								
							
PDF, PNG and JPG files allowed
                    
                    
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                        How much do you need?
Microgrant Justification
Please explain what you will use the microgrant for and why you are a good candidate for the grant.
Attestation
I swear under penalty of perjury that all information provided is true and complete to the best of my knowledge. In addition, if requested, I will provide three (3) months of bank statements, pay stubs, or other comparable proof of income status.  I authorize Colorado Name Change Project and/or the Court to make any necessary contacts to verify the information provided.
Signature*
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