Apply to Become Part of our Network

Thank you so much for your interest in partnering with The FitzLane Project to help support underprivileged transgender youth in the Greater Tampa Bay, Florida area.​

In order to match you with individuals seeking assistance, we ask that you complete the below form to the best of your ability. We understand that some questions may be personal in nature. These are asked in an effort to help pre-match potential clients who are looking for certain characteristics in a mental health provider. If you do not feel comfortable answering any question, feel free to leave it blank.

We understand that your commitment to The FitzLane Project is long term and the contents of this form may change over time. Because of this reason, please complete the form based on your current situation. If you have material updates in the future, you can provide these updates by sending an e-mail to alivia@TheFitzLaneProject.org.

Questions for General Information

These questions are used to obtain basic information about the individual applying for assistance. If you are a guardian applying for assistance for a child, please also provide your name and contact information in the free form area.

Preferred method of communication?
Do you identify as part of the LGBTQIA+ community?

Logistics for Client Matching

Preferred method of sessions?
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What days of the week you prefer to conduct therapy sessions?
What times of the day you prefer to conduct therapy sessions?

Financial Information

Please note that there is not cost associated with becoming part of our network. This section is strictly to gain information on how you prefer to be compensated for your time. You are NOT expected to provide your time and services free of charge.

In an effort to provide as much funding as possible to our community, The FitzLane Project is requesting a set hourly rate with each of our network providers that you feel is reasonable for your time and services. This is often similar to a discounted price that a provider may offer to clients based on sliding income scales.

What method of payment do you prefer?

Social Media Links

Thank you so much for taking the steps to support the underprivileged transgender youth in our community. Someone from The FitzLane Project will be in touch with you within 5 business days.