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The Mental Wellness Collective Texas Flood Relief Provider Application 

Thank you for your interest in partnering with The Mental Wellness Collective and Safe Haven Counseling to offer therapy to those impacted by recent flooding in Texas.

Selected providers will deliver up to 10 therapy sessions per client, reimbursed at $50 per 50-minute session.

Please complete the application below. Submitting this form does not guarantee selection. You will be contacted for a virtual interview if selected.

Priority will be given to those serving under-resourced and flood ridden areas as well as those specifically impacted by the loss of a loved one or first responder who have cared for those impacted by Texas flooding.

You must be licensed and verified (LMSW, LCSW, LPC, LMFT ) through BHEC to be selected, and have trauma-informed training or experience working with crisis/disaster-impacted clients. You must also be on the Safe Haven Counseling provider page found here https://safehavencounselingtx.com/resources. Please fill this out if you have not already before submitting your application.

Please email connect@the-mwc.org for questions

Email *
First  Name *
Last Name *
License type + number (LPC-Associate, LCSW, LMFT, etc) *
Practice name *
Preferred email  *
Preferred phone number *
Website *
Practice address including zip code. If virtual only, please indicate. *
Do you carry liability insurance, minimum $1,000,000 coverage? *
 Do you have experience with trauma, crisis care, or disaster mental health? If yes, please list. *
I am interested in working with *
Required
Language(s) spoken to provide therapy
Why are you interested in serving those affected by the Texas flooding? A brief statement is sufficient and you consent to allowing us to share your response as we promote our working relationship. *
Please read and check each box to acknowledge your agreement: *
Required
Please type your full name as your digital signature. *
date *
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