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Eating Disorder Scholarship Application
Please complete this application honestly if you think you may be eligible for receiving this scholarship for one year of provided counseling to recover from your eating disorder.
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* Indicates required question
Email Address
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Your answer
Name
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Your answer
The individual meets the diagnostic criteria for an eating disorder according to the DSM. see link:
https://www.eatingdisorders.org.au/eating-disorders-a-z/what-is-an-eating-disorder/
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Yes
No
Are you between the ages of 12-18? *
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Yes
No
What is your age?
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Your answer
Is your household income of $75,000 or less? *
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Yes
No
What is your approximate household income? *
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Your answer
How many individuals are in your family including yourself? *
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Your answer
Explain how you display motivation towards recovery by being in the preparation and action stage of recovery. *
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Your answer
Are you appropriate for outpatient care according to APA guidelines. see link:
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
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Yes
No
Are you willing to share your story in effort of inspiring and helping others once at a maintenance stage of recovery? *
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Yes
No
Please explain why you think that you should be the one individual to receive this scholarship for one year of provided counseling. *
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Your answer
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