Counseling Scholarship Application

Thank you for applying for scholarship support through this application. Approved caregivers will either have their entire therapy sessions or their co-pays covered. Applications are reviewed at the end of every month, and applicants are contacted regarding their status by the 15th of the following month. Caregivers can use this scholarship to see one of our approved counseling providers.

Name
Address
What is the best way to contact you?
Do you currently have insurance?

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