Scholarship Application. Rooted in Hope

Scholarships Rooted In Hope

First Name

Last Name

Email

Occupation.

Agency:

Private Practice:

County of Residence:

County of Work:

Client Age Range:

BIPOC Representation: Information regarding the practitioner's own background and identifying as Black, Indigenous, or People of Color, which can be relevant for clients seeking an individual with shared lived experiences?

Yes

No

Service to Marginalized/Underserved Communities: A description of the practitioner's experience, specialization, or dedication to providing services to communities that have historically faced barriers to accessing mental health care, including but not limited to LGBTQ+ individuals, low-income populations, individuals with disabilities, immigrants, or rural communities. This could also include information on sliding scale fees, pro bono work, or culturally competent approaches.

Yes

No

Submit Form