Search
Close this search box.
0
Edit Content
0

Credit Card Authorization

This is a contribution for a 50-minute session at a $85.00 suggested rate. Written permission is needed by your counselor to make a contribution here to secure the counseling date requested. 

All donations are tax-deductible (See Tax Exempt Certificate). Please make sure to fill out all fields and read the form carefully. If this form is not completed or is filled out incorrectly, it will be disregarded.

If you are experiencing economic hardship, please fill out a Counseling Scholarship Request to see how we can assist you.

Credit Card Authorization

"*" indicates required fields

We will not contact your employers. If not working, input "NA".
Access and upload your most recent Tax Return Transcript following this written or video tutorial.
File can be .jpg, .png, .gif, .pdf. The tax form should show the latest filing information for your household.
Max. file size: 128 MB.

Create a new account

"*" indicates required fields

Step 1 of 3

Step 1: Basic Information

Birthdate*

We Have
Moved & Upgraded

9050 Pines Blvd Suite #358 & Suite #363, Pembroke Pines, FL 33024