A joint project by Equality Texas and Texas Pride Impact Funds.

SECTION ONE - Ten quick questions about you/your organization.

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* Organization Name:

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* 501(c)(3) Tax ID: (may be a fiscal sponsor)

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* Contact's Name

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* Contact's Title

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* Contact's Email Address

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* Contact's Phone

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* What is your organization's current annual operating budget?

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* Is your organization utilizing volunteers during COVID-19?

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* What is the race/ethnicity of your CEO/Executive Director?

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* Is your CEO/Executive Director a transgender, non-binary, or other gender diverse person?

SECTION TWO: Please tell us about your Patients, Clients and or Service Users.

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* ESTIMATE the number of unduplicated LGBTQ+ Texans your organization is likely to serve over the next 90 days.

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* What percentage of your patients/clients/service users are under 18.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are 18 – 24 year-olds.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are transgender, non-binary, or other gender diverse people.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are older adults (65+). 

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are African-American/Black.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are Hispanic or Latinx.

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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* What percentage of your patients/clients/service users are people living with HIV?

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.
SECTION THREE: Only four more questions about your organization!

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* Tell us how COVID-19 has impacted your organization, i.e.staffing,  financially and retooled programming. (Please limit your response to 25 lines.)

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* How does your organization's work support or address the needs of LGBTQ+ people of color. In doing so, please identify which communities of color your organization serves and your efforts to reach this/these communities.

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* If you were to receive a grant from the Queer Texas Crisis Fund, how would your organization use the funds?  (Please limit your response to 25 lines.)

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* Is there anything else you’d like to share with us about your organization’s and communities' current situation or anticipated future? (Please limit your response to 25 lines.)

Thank you for participating in the QTCF survey. Please note that since there will not be site reviews (virtual or otherwise), the Grants Committee for QTCF may request a phone call, if needed, to clarify survey responses.

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