Therapy Grant Application
The Long Island Institute of Sex Therapy (LIIST) has 2 grants available for 2 individuals, couples, relationships, families, or households where at least one member is in a racialized group.

Your sessions will be free for up to one year, and will be with LIIST staff therapist Wildilisa Silverman, who will be paid her usual rate.

Your eligibility for this grant will be determined by Wildilisa Silverman and Dr. Torrisi. To apply, please fill out this form.

We will put out another notice when the 2 grants have been distributed.

*Why the term racialized?*

We live in a society deeply steeped in racism and ethnocentrism. This systemically harms people who are Black, Latinx, Indigenous, Middle Eastern, East Asian, Pacific Islander, and many others.

This term is used to be inclusive of the many identities that are racialized within a racist and ethnocentric society.

A common and similar term is BIPOC.
Full Name You Go By *
Date of birth *
Email *
Address - # and Street *
Address - City, State, Zip *
Cell phone *
Other phone
Career Field
I work___ *
Race *
Ethnicity *
Would you be able to attend therapy in either English or Spanish? *
Gender *
Gender pronous
Sexual orientation
Clear selection
Untitled Title
Untitled Title
Clear selection
Current relationship status
Clear selection
Never submit passwords through Google Forms.
This form was created inside of The Long Island Institute of Sex Therapy. Report Abuse