The Loveland Therapy Fund - Waitlist Form

THIS FORM IS NOT AN APPLICATION. - Filling out this form does NOT guarantee Loveland vouchers

Thank you for your interest in The Loveland Foundation’s Therapy Fund program. 

Applications for new Therapy Fund cohorts open on a limited, quarterly basis. 

Registration is currently closed. To be notified when we’re accepting signups again for the next available cohort, please fill out the form below. 

Please note: When new cohort registrations open, the application must be completed by the individual who will be using the vouchers. Family members, friends, therapists, or other third parties may not complete a Therapy Fund application on behalf of someone else.

Thank you,

Team Loveland

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Email *
Last Name *
First Name *

Phone Number

 *
I have received Loveland vouchers in the past. *
I was previously accepted into a Loveland Cohort but did not finish use of my vouchers.  *
I am completing this form for:
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