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Request - Binder 21-22
Binder Request Form
Do you live in Maine?
You must live in Maine in order to receive a binder.
You do not qualify for a binder. Do not press submit.
This program is only open to youth in Maine.
Are you between the ages of 14 and 22?
You must be at least 14 years old to request a binder, but no older than 22.
You do not qualify because of your age. Do not hit submit.
This program is only open to youth between the ages of 14 and 22.
Date of Birth
Name (Preferred Name)
Address Line 1
Address Line 2
Binder Style Preferences
We will send you a binder in whatever color or length is available in your size. If you have a preference for color and/or length, we will check to see if it is available.
Please indicate if you prefer a short (covers chest area only) or long (covers whole torso like an undershirt) binder. The material that covers the stomach in the long binder is thinner and more stretchy than the material that covers the chest.
Please check off which colors you prefer.
Binder Color Guide
Check the box to confirm you are eligible for the program.
I am between the ages of 14 and 22, have read "How to Apply for a Binder" and measured myself to determine the binder size I need.