Intake Form 1Individual2Health3Legal System4Relocation5Contact Info Housing Assistance FormAt Transitional Justice, we understand the challenges faced by individuals seeking refuge from anti-trans legislation. We are dedicated to providing safe and supportive transitional housing to those in need. To ensure the best possible placement, we kindly request individuals to complete the contact form, which may include sensitive information. By gathering details such as legal and preferred names, date of birth, gender identity, health information, and additional relevant information, we strive to personalize our support and connect individuals with sponsors who can provide understanding and assistance specific to their needs. We handle all personal information with the utmost care and adhere to strict privacy regulations to safeguard the privacy and well-being of those escaping anti-trans legislation. Your trust in us empowers us to create a secure and inclusive environment during your journey towards safety and stability. If you require assistance filling out this form, please contact us at [email protected]. Your Preferred Name(Required) First Last Legal Name Same as preferred Your Legal Name(Required)We will never ever refer to you by your legal name if it differs from your preferred name. We will only use this information for our secure vetting process. First Last Gender Identity(Required)Gender identity is an individual's own understanding and identification of themselves in terms of their gender, regardless of societal expectations or norms.Trans MaleTrans FemaleGender QueerNon-BinaryCisgender MaleCisgender FemaleAgenderPronouns(Required)Words that reflect how individuals wish to be referred to when others talk about them. They/Them/TheirsHe/Him/HisShe/Her/HersShe/He/TheyXe/Xir/XirsFae/Faer/FaersEy/Em/EirI prefer to be referred to by my nameDate of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Last 4 of SSN - IF NOT APPLICABLE, PLEASE INPUT 0000(Required)We require this information to ensure accurate and secure identification. Collecting SSN data allows us to verify identities, prevent identity theft or fraud, and facilitate necessary legal documentation or financial assistance where required. We want to assure you that your SSN will be handled with the utmost confidentiality and stored securely in compliance with privacy regulations.Racial Background(Required)At Transitional Justice, we recognize the significance of racial diversity and the unique challenges faced by individuals from different racial backgrounds. We ask for information regarding racial background as part of our efforts to promote inclusivity, equality, and culturally responsive services. Native American/Alaskan NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderHispanicWhite / CaucasianMultiracial Health QuestionnaireWe prioritize the well-being and safety of our residents. As part of our commitment to providing comprehensive support, we kindly ask individuals to provide brief medical information. This helps us ensure that we can address any specific health concerns or provide necessary accommodations to create a safe and supportive environment. Understanding individuals' medical needs, such as any medications they may be taking or existing health conditions, allows us to tailor our services and resources accordingly. Do you require mobility assistance?(Required)As part of our commitment to ensuring your comfort and safety we do inquire about mobility assistance. This information helps us better understand specific accessibility requirements and make necessary accommodations to support individuals that may need assistance. Yes No Occasionally Do you take regular medication that you'll need assistance sourcing when you move?(Required) Yes No Unsure Will you need mental health resources when you move?(Required) Yes No Unsure Please Upload Photo ID(Required) Drop files here or Select files Accepted file types: jpg, pdf, tif, psd, png, heic, Max. file size: 128 MB. Legal System QuestionsWe want to ensure we provide the best support and accommodations for everyone, and understanding any relevant circumstances can help us create a safe and suitable environment for everybody. Please feel free to share any information you are comfortable with, and rest assured that your privacy will be respected.Have you ever been arrested?(Required) Yes No Convicted of Felony or Misdemeanor?(Required) Felony Misdemeanor Both Not Applicable Please Explain(Required)Are you Currently on Probation?(Required) Yes No When is Your Probation Complete?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Relocation QuestionsPlease let us know what your current housing situation is and where you'd like to move to.First Choice - Relocation(Required)We currently have hubs in Minneapolis, San Francisco, and Denver. What is your top relocation choice?Minneapolis, MinnesotaDenver, ColoradoSan Francisco, CaliforniaSecond Choice - Relocation(Required)Minneapolis, MinnesotaDenver, ColoradoSan Francisco, ColoradoThird Choice - Relocation(Required)Minneapolis, MinnesotaDenver, ColoradoSan Francisco, CaliforniaIs there another preferred location that isn't listed above?(Required)Is there an area that isn't mentioned where you already have a safe community or where you'd prefer to go? Please list it below!Do you have any connections in the listed locations?(Required)Do you have any friends or family in any of the locations listed above? If yes, please provide more detail.What Best Describes Your Current Housing?(Required)Whether you own your home, rent, or if you're facing any housing challenges, any information you feel comfortable sharing will enable us to better assist you in finding suitable resources and options. Your privacy and confidentiality are of utmost importance to us, and we respect your decision in sharing this information. Please know that we are here to support you.HomeownerRenterHomelessCouch SurfingShared HousingSubsidized HousingPublic HousingSenior HousingGroup HomeCurrent Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How much can you afford monthly for rent?(Required)After your transitional housing assistance concludes, about how much will you be able to afford for rent?Please enter a number greater than or equal to 0.What is Your Timeline for Moving?(Required)How soon would you like to be relocated?ASAP1-2 Months3-6 MonthsHow Long Do You Anticipate Needing Temporary Housing?(Required)1 Week - 1 Month2 - 3 Months3 - 6 Months6 + Months Contact InfoPhone Number(Required)Email(Required) Enter Email Confirm Email Preferred Communication(Required) Phone Email If There Anything Else You'd Like to Share?EmailThis field is for validation purposes and should be left unchanged.