PSI-GA Chapter 2020 Scholarship Application
In partnership with the Georgia Department of Health, the PSI GA Chapter is providing several scholarships for upcoming 2020 trainings. We are looking for providers, who work directly with mothers and children, who are interested in furthering their education and understanding of perinatal mental health. Applicants working in rural areas and/or with under-served populations are encouraged to apply and you must serve residents of GA for consideration.

This scholarship is to be applied toward registration fees ONLY and can not be used for hotel, travel expenses or additional meal reimbursements.

PLEASE NOTE: We are only offering scholarships for the Maternal Mental Health Online Training (8 weeks long; 9/14/2020 - 12/14/2020) and the 2-Day Perinatal Mood and Anxiety Disorder Training (11/12/2020-11/13/2020).

For more information about PSI's trainings, please visit: https://www.postpartum.net/professionals/trainings-events/

If you have any additional questions about this Scholarship, please contact Laytrina Clemons-Brown at Laytrina.Clemons-Brown@northside.com.
Email Address *
First and Last Name *
Occupation *
Employer *
Business Address *
City, State and Zip code *
Contact phone number *
Website (if applicable)
Please select your title(s):
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License Number
If you are working toward licensure, when do you expect to be completed:
Are you licensed in any states other than Georgia? *
If yes, which states?
Do you currently work with the Perinatal or Postpartum population? *
If no, please explain your interested in taking the 2-day training:
If yes, what percentage of your pregnant or postpartum clients are uninsured?
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What percentage of your pregnant or postpartum clients are privately insured?
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What percentage of your pregnant or postpartum clients are on public insurance or Medicaid?
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What percentage of your pregnant or postpartum clients are from rural areas?
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What percentage of your pregnant or postpartum clients are from a racial or ethnic minority?
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Are you currently accepting new clients/patients? *
Are you bilingual? *
If yes, please list languages:
Do you offer Online Therapy (Telehealth or Tele-psychiatry)? *
Do you offer a Sliding Scale? *
Do you offer any Pro Bono services? *
Do you accept insurance? *
If yes, please list all insurances:
Do you accept Medicaid? *
Do you practice in multiple locations? *
If yes, please list the cities/hospitals:
Have you attended a perinatal mental health training before? *
Do you currently Volunteer with the PSI-GA Chapter? *
I understand that I must serve residents in GA to be considered: *
Required
I understand that this application must be completed and submitted by October 16, 2020, to be considered: *
Which training would you like to attend and which dates work best for you? (Options: 2-Day PMAD Training or Maternal Mental Health Online Cerfiticate Training) *
Is there anything else you’d like the Scholarship Committee to know/consider?
Do you have any other questions?
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