BroadcastHER Agreement

Term

Name(Required)

First Middle Last

Please put in your legal name (middle not required).

Chosen Name

First Last

If your chosen name differs from your legal name, please put that here! This is never shared externally - but this is important for something such as a mailed check to ensure we do not include it unless requested.

Birth Date

Twitch username if applicable

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your gender?(Required)

Please select all that apply, this information will not be shared publicly.

Sexual Orientation(Required)

Please select all that apply, this information will not be shared publicly.

Phone(Required)

What is your ethnicity? (Please select all that apply)(Required)

Email(Required)

College/University

N/A if not applicable

Field of Study

N/A if not applicable

Anticipated Graduation Date

Leave blank if not applicable

Payment Method(Required)

Please keep in mind that PayPal is our only method to pay international recipients, as well as, our FASTEST payment method - if you might need accommodations or have questions please feel free to email BroadcastHER@1000DreamsFund.org

Please share your payment method email to send your reward payment if this is your preferred method.(Required)

If you chose check, please reconfirm the address.

Please share the address your check should be sent to if different from above.(Required)

Also please share any details about a different addressee name that we should know.

How will this grant be used?

I hereby understand and accept the terms of this grant award, as specified in my award letter that was provided to me. Further, I understand the following:

(a) My award is only for the current year, unless otherwise stated in my award letter;
(b) I will use my funds for the intended purposes in outlined in my answer to the question: "How will this grant be used?"
(c) If I do not meet the requirements explained to me in my award letter, I forfeit any unpaid payments. (d) We work on a Net90 payment system. Meaning that we typically will pay out your grant 90 days from the day we receive ALL forms required, including your online profile as applicable.

Agreement(Required)

I understand

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