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Community Healing Scholarship Application
Thank you for your interest in working together! Please fill out this form and I will respond within 3 business days to schedule a free phone consult to discuss your application. If scholarship appointments are currently filled, I will place you on a wait list and notify you when appointment space becomes available.
Email address *
Name
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Pronoun(s)
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Email & Phone number
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What do you need support with?
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Why is this option right for you?
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Why do you think I'm the right person to support you?
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Are you able to commit to all 6 sessions?
Please share any questions, concerns or thoughts you might have
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