Pro Bono Scholarship Application
Thank you for your interest in our pro bono scholarship program. We understand that seeking therapy can be a significant financial challenge for some individuals who do not have healthcare insurance coverage. To assist those in need, we are offering a limited number of scholarships to provide access to free therapy for a duration of three months. These scholarships are specifically designed for individuals who demonstrate a financial need and are seeking brief, solution-focused therapy. We encourage those who meet these criteria to fill out our questionnaire to apply. 


Terms and Conditions: 
1. Eligibility: The scholarship is available to individuals who fulfill the following requirements: a. Demonstrated financial need: Applicants must provide proof of financial need, such as proof of income or eligibility for government assistance programs. b. Lack of healthcare insurance coverage: Applicants must currently not have healthcare insurance coverage for therapy or counseling services. c. Commitment: Applicants must be committed to actively participating in brief, solution-focused therapy for the full three-month duration. 2. Scholarship Coverage: Successful applicants will receive access to free therapy sessions with a clinical resident for three months. The scholarship covers the cost of therapy during this period. 3. Brief Short-Term Therapy: Please note that this scholarship is specifically intended for brief, short-term therapy. The exact number of sessions will depend on the individual's needs and the clinical resident's assessment. 4. Application Process: To apply for the pro bono scholarship, interested individuals must complete a brief questionnaire. The information provided will help us determine eligibility and suitability for the program. 5. Confidentiality: All application information and subsequent therapy sessions will be kept strictly confidential in accordance with applicable laws and regulations. 6. Limited Availability: The scholarship program has limited availability, and the selection of successful applicants will be based on their eligibility, financial need, and commitment to therapy. 7. Termination: The scholarship will automatically terminate after the three-month period. If further therapy is desired, alternative arrangements and/or fees will need to be discussed with the therapist. 8. Program Changes: We reserve the right to modify or terminate the scholarship program at any time without prior notice. Please note that the pro bono scholarship program is subject to the availability of clinical residents and resources. We appreciate your understanding and hope that this program will provide valuable support to those in need.p
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First Name *
Last Name *
Home Address *
Phone Number *
Email address *
What is your financial situation and why do you believe you qualify for this pro bono scholarship?
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Have you ever received therapy or counseling services before?  If yes, please provide details.
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What specific mental health concerns or challenges are you currently experiencing?
Describe your commitment and availability to attend therapy sessions regularly for the duration of the scholarship.
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Have you previously applied for any other scholarships or financial assistance programs for therapy?
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Are you currently receiving any other mental health services or treatments? 
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Are you comfortable working with a clinical resident for your therapy sessions? 
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Are you available to attend therapy sessions online? 
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Are you over the age of 18?
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Are you currently residing in NY, NJ or CT? (Please note we are only able to meet with clients located within these states.
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