Fund Texas Choice

Application for Transportation Assistance

Thank you for reaching out to Fund Texas Choice. Please fill out this form as best you can, and someone will get back to you within a few days. None of the fields are required, but the more information you give us, the better.
 
We deeply respect your privacy and will keep all of your information confidential. However, if you have any concerns about the security of the computer, phone, or tablet you are using to fill out this form (for example if it is a public computer or belongs to someone else who doesn't know about your situation), we recommend that you do not begin the application until you can use a more secure device. Or, you can call our hotline at 844-900-8908, pressing extension 0. If you call us on the phone, we will ask you all these same questions -- no surprises.
 
If you need other resources, don't forget to check here.
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Who is filling out this form?
 
Do you need assistance with transportation or lodging for your appointment? PLEASE NOTE: This is the only kind of assistance Fund Texas Choice provides. IF NOT, please look at our other resources at www.fundtexaschoice.org/need-help.
 
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Age of the person with the appointment
 
PLEASE NOTE:  If you are a relative or friend filling out this application for a minor, we will need to speak with them directly to get consent before we will provide funding.
Whose phone number is this?
 
Will the person with the appointment have access to this phone while traveling?
 
Is it safe to leave a detailed voicemail on this phone?
 
Is it safe for us to text this phone?
 
If someone else answers the phone, can we talk to them?
 
Do you have an appointment already?
 
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What state are you starting out in? Please note that Fund Texas Choice can only fund people who start out in Texas.
 
What city do you need to get to?
 
What state is your appointment in?
 

 
If you're already in the same city as your clinic, please contact a local volunteer driver network:
 
HOUSTON: Call or text Clinic Access Support Network: (281)  947 – 2276
 
DALLAS or FT WORTH:  Call the Cicada Collective: 940-441-3337.  Or, fill out a form on their wesbite: http://www.cicadacollective.org/contact.html 
 
AUSTIN or SAN ANTONIO:  Call The Bridge Collective: 512-524-9822.

Were you planning on driving?
 
Would you be willing to take a bus?
 
Do you have a place to stay once you get there?
 
Do you know anyone in the city where you're going?
 
Is someone coming with you?
 
What's the name of the clinic you're going to?
 
PLEASE NOTE:  We are only able to fund people traveling to the closest clinic that can serve them. If the appointment is not at the closest clinic, please explain a little why.
Do you have health insurance?
 
Have you gotten funding from any other organizations?
 
Are you experiencing medical complications?
 
If you have kids, do they have someone to stay with during this trip? (We only ask because the clinic won't let you bring them in with you, so childcare must be arranged before travel.)
 
Do you have a photo ID for travel purposes? (NOTE: Gotidtexas.org or 1-866-OUR-VOTE may be able to help you get an ID and you can still get a state ID if your driver's license is invalid for legal reasons.)
 
Do you have access to the internet?
 
How did you hear about us?
 
Would you be willing to speak (anonymously if you want to) to a reporter or journalist about your experiences?
 
If you're going to Austin, Dallas, Fort Worth, or Houston there are organizations that provide volunteers for emotional support. Would you like us to submit an application to one of these organizations on your behalf? They will contact you directly after we submit the app.
 
NOTE: By clicking "Next" you are SUBMITTING YOUR FORM. Be very sure that you are ready to submit!
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