Q32024 - Indigenous Women Rising Abortion Fund Form

Indigenous Women Rising

Please read this carefully: This fund is for Indigenous/Native American people.
For Indigenous/Native American people, we will accept:
- Your CIB/Tribal ID
- A relative's CIB/Tribal ID with proof of your familial relationship(parents, grandparents, great-grandparent, etc. only).
- IHS or tribal clinic communication or prescription
- Per capita payment stub
- If appropriate for your community, a picture of you in regalia
- Student ID or paperwork from a Tribal institution (K-12, trade school, university, etc.).
- Please text/call 505-932-9759 OR email iwraf@iwrising.org if you have any questions about providing proof of tribal affiliation. We are flexible with what we accept but do require some proof of tribal affiliation.
WHY DO WE ASK FOR THIS? There are people who are not Indigenous/Native American who have used stereotypes about Indigenous people to get funding. There are no other Indigenous-centered abortion funds in the country and we are doing our best to serve our communities while acknowledging the harmful and racist past of blood quantum. We also recognize Indigenous peoples who don't have any of these pieces of documentation- please call/email/text us so we can work with you. Thank you for seeing us as a trusted resource for your sexual and reproductive health needs.

In love and solidarity, Eztli & Andrea
Has this pledge been sent?

YesNo
Has this account been paid?

YesNo
A/D

ApprovedDeniedPending
What is your name?*

First NameLast Name
What is your date of birth?*

MonthDayYear
Make sure to select the correct YEAR
What are your gender pronouns?
They/Them, She/Her, He/Him, etc.
Are you Native American/Indigenous/Tribally-affiliated?*

YesNo
What is your tribe? *
Please upload a picture of your Certificate of Indian Blood (CIB), letter of descent, or any other proof of belonging to an Indigenous community.

You can upload multiple documents at once. Please call or text 505-398-1990 if you need assistance or clarification on this requirement.
Cancelof

Personal/Contact Information
Phone Number*
Please enter a valid phone number.
Best way to contact you? Select all that apply.*

Phone callEmailText
Is it safe to leave a voicemail or text?*

Text onlyVoicemail onlyText and voicemail are safeText and voicemail are NOT safe
Email*
Type N/A if you don't want to share your email address
What country do you reside in? City? State?
If not listed above, what city and state do you reside in?
If not the countries listed above, what country?

Appointment Information
Do you have an existing appointment set up?*

YesI am waiting to order pills-by-mailNo
Are you interested in the pill, procedure or need more information?*

PillProcedureNeed more information
When is your appointment?*

MonthDayYear
You must have an appointment scheduled before submitting this form. If you are ordering pills-by-mail, enter today's date. Please note if you are submitting this form 24 hours before your appointment, we cannot guarantee funding.
What clinic is your appointment scheduled at? If you are not going into a clinic, what telehealth provider are you receiving care from?*
You MUST include the name of the clinic and the clinic address if you are going in-person.
What was the estimated cost? If they didn't give you one, type N/A*
AB$ (Projected)

How many weeks pregnant are you?*
Do you need help with other accommodations?*

GasLodgingTransportation tickets (plane, train, bus, etc.)FoodChildcareNo, I don't need any additional help
What is your Paypal email/ Venmo username/ $Cashapp username?
We will send you these funds AFTER your appointment. If you are requesting reimbursement or help with accommodations besides your procedure, these are the best ways to send you funds quickly.
Have you ever reached out to either of the following services for help:*
What did they tell you, what resources were provided?*
Please provide as much detail as you can.
How did you hear about the Indigenous Women Rising Abortion Fund?
Is there anything else you want us to know?

Our focus is to serve our Indigenous/Native American relatives by supporting them to exercise their bodily sovereignty. We have funds for abortion procedures and practical support but are limited by our monthly budget. If able, we may extend support to those who are not tribally-affiliated if you fall into the following categories (please select if any apply to you):*

UndocumentedMinors (-18)3rd trimester pregancyUnhousedPeople of colorNone
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Indigenous Women Rising

Personal/Contact Information

Appointment Information