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Gender Affirmation Program Application

About the Program

Diversity Cornwall, in collaboration with the United Way of Stormont, Dundas and Glengarry, has implemented a Gender Affirmation Program (the “Program”) in order to help alleviate some of the costs incurred by individuals who identify as trans, two spirit, gender non-binary or gender non-conforming. The Program provides funding on a cost reimbursable basis for various gender affirming goods and services. The maximum amount that can be reimbursed under the Program is $1000 per applicant per calendar year. Approval of Program applications is dependent upon the availability of funding. Applicants are encouraged to submit their application in advance, in order to confirm that funding is available, prior to incurring any costs.

 

Eligibility Criteria

Applicants must identify as trans, two spirit, gender non-binary or gender nonconforming.

 

Applicants must reside in Cornwall, Stormont, Dundas, Glengarry or Akwesasne.

 

How It Works:

Diversity Cornwall will review and approve applications under the Program on a first come first served basis. Upon approval from the committee, Diversity Cornwall will purchase and/or reimburse the cost of gender affirming goods and services, up to a total of $1000 per calendar year in all categories. Except in the case of reimbursement of mileage, proof of payment will be required prior to reimbursement. Some of the categories of goods and services available to be reimbursed under the program are detailed below. Other goods or services may be reimbursable under the program upon request, as detailed in subsection 7, below.

 

1. Gender Affirming Clothing

Items Diversity Cornwall will reimburse or purchase on your behalf gender affirming clothing items requested in the size required. Items that are eligible include (but are not limited to) binders, STPs, gaffs and chest forms. Diversity Cornwall is willing to consider other items upon request.

Recommended Source:

The following link is provided as a recommendation only. Applicants may request items from other sources.

Gender Gear – gendergear.ca

GenderGear is a trans and gender variant owned co-operative located in Ontario. They offer a variety of gender affirming items such as chest binders, gaffs, packers, STPs, packing straps and pouches, breast forms and bras, lower half shapewear, dilation devices, and more.

2. Reimbursement for Legal Name Change

Upon approval of the application, Diversity Cornwall will reimburse the cost of legal name changes following proof of name change and proof of payment (receipt). Instructions are available for residents of Ontario. All residents of Akwesasne are eligible and can submit receipts for legal name changes processed by the Province of Quebec or New York State, as required. Diversity Cornwall will also cover costs related to criminal record checks or other fees required to process a legal name change. Diversity Cornwall has also entered into partnership with Journey Law and Cornwall Community Police Service in order to provide access to notary services and criminal record checks required for legal name changes at no cost. Applicants are encouraged to inquire about these services prior to incurring any costs related to legal name changes.

 

3. Mileage 

Upon approval Diversity Cornwall will reimburse for mileage incurred to travel to and from gender affirming appointments. A signature from your medical professional is required to reimburse travel related to each appointment.

 

4. Mental Health Support / Counselling Services

Upon approval, Diversity Cornwall will reimburse applicants for counselling services from licensed/accredited mental health professionals, counsellors, or therapists for trans, two spirit, gender non-binary or gender non-conforming individuals. Applicants will be required to sign a waiver indicating that the costs are not reimbursable under any benefit or group insurance plans.

 

5. Cosmetic Services / Hair Removal

Upon approval, Diversity Cornwall will reimburse applicants for cosmetic services and hair removal services for trans, two spirit, gender non-binary or gender non-conforming individuals.

 

6. Voice training

Upon approval, Diversity Cornwall will reimburse applicants for voice training services. These services must be offered by a registered business and must be gender affirming in nature.

 

7. Other gender affirming goods/services

Diversity Cornwall is willing to consider requests for other gender affirming goods or services, with the exception of pharmaceuticals and gender affirming surgeries, upon request. If you would like to request other gender affirming goods or services, please describe them below.

REIMBURSEMENT FOR LEGAL NAME CHANGE
Residents of Ontario 

You can change your name as an adult if you:

  • Are 16 years of age or older

  • Have lived in Ontario for the past 12 months Please note if:

  • You’re 16 years or 17 years old, you will need consent from every person who has legal custody of you before you can change your name (you must complete Part 3 of the application)

  • You’re married or have signed a Joint Declaration of Conjugal Relationship document, you must give you partner/spouse notice that you’re changing your name (you must complete Part 2 of the application)

  • You need a police record check as part of your legal name change application – the Cornwall Police Service has partnered with Diversity Cornwall to offer this service free of charge for GAP applicants. As such, this expense will not be reimbursed. If you are applying for a police record check outside of the City of Cornwall for the purposes of this application, please contact Diversity Cornwall in advance

 

The cost to legally change your name in Ontario is $137 How to Apply:

ServiceOntario

Office of the Registrar General

P.O Box 3000

189 Red River Rd,

Thunder Bay, On

P7B 5X0

Residents of Akwesasne

You are eligible for reimbursement for the cost of your name change, even if outside of Ontario.

You may submit your application with the total cost expected for approval; however, reimbursement will only occur once proof of name change and payment have been received. 

MILEAGE CLAIM INSTRUCTIONS

Complete the Mileage Claim document and submit to gap.diversitycornwall@gmail.com. Only claims with a signature from your medical professional will be accepted.  

Please complete the Mileage Claim Form attached to the pdf Application Form

(Accessible with Adobe Acrobat Reader) or it can be downloaded from the website at diversitycornwall.ca or contact gap.diversitycornwall@gmail.com.

PLEASE FILL OUT THE BELOW FORM TO APPLY

Preferred method of contact
Goods or Services Requested
Are you looking for reimbursement of costs already incurred?
Upload File
Are you requesting support for mental health/counselling services?
If Yes, please fill out the waiver form, sign and upload here. 
Upload File
Are you requesting support for mileage to gender affirming appointments?
If Yes, please fill out the mileage claim form, sign and upload here. 
Upload File
Please provide details regarding goods and services being requested:*
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