Counseling Scholarship Request

Please submit your scholarship request. Our scholarship team will contact you when ready to review your scholarship with acceptance or rejection. If you have an emergency, please dial 911 and seek medical or mental health help immediately. The scholarship process is not for people in dire need but those who can be patient through our process.

We process Health Savings Account (HSA) or Flexible Spending Account (FSA) cards when booking your first or regular visit appointment. Learn more about HSA and FSA.

We do not receive most forms of insurance due to the Christian Spiritual emphasis of our counseling and our faith-based licensing. Some of our counselors are state licensed and may take certain forms of insurance. Please contact us for more information.

First Name *

Last Name *

Primary Email *

Primary Phone *

Address 1 *

Address 2 *

City *

State *

Zip Code *

Which Counselor Interested In *

Explain Your Counseling Needs *

Reasons For Economic Distress *

Family Size *

Household Income *

Employer(s) Name *

We will not contact your employers. If not working, input "NA".

IRS Tax Return Transcript Tutorial

Access and upload your most recent Tax Return Transcript following this written or video tutorial.

Upload Your Most Recent Tax Return Transcript *

Drag and drop files here or Browse

File can be .jpg, .png, .gif, .pdf. The tax form should show the latest filing information for your household.

Message