Apply for a Scholarship

Genesis Family Scholarship Foundation

Professional and high-quality therapy and coaching can be expensive, so what happens when an individual or family cannot afford it?

With the purpose of making professional help more accessible to all, including to those who cannot afford services, Genesis Family Incorporated was founded. This non-profit entity was established with the sole mission of providing financial support to those in need of mental health services and is funded through the generous donations of local churches, partnering organizations, and individual donors.

Scholarship Application

First name

Last name

Phone number

I'm applying on behalf of:

Service Type Requested

In a few sentences, please describe the presenting problem (the reason the applicant is seeking help):

Financial Information

(on which to prove financial need for a scholarship)

Net monthly household income

Monthly household expenses

Please upload two recent paystubs (if this is incomplete, you will be asked to submit these prior to your scholarship being processed)

Declaration

I declare that I am financially unable to pay for mental health services at Genesis Family Foundation LLC. The issue described above is too severe that I cannot wait with getting help for the applicant until I have sufficient funds. I give permission to the Genesis Family Private Operating Foundation to share my presenting problem, WITHOUT sharing personal data, to potential donors/sponsors that might be willing to pay for these services.

I give Genesis Family permission to reach out to third parties whom are known (potential) sponsors with a message along the lines of: “Someone is in need of your help today. He/she is struggling with [insert presenting problem], and cannot receive the help they need without sufficient funds to provide for a therapy scholarship.”

Genesis Family will never identify you, share your contact information or any other personal health information with third parties.

I declare that all information I have provided on this application is correct and true to the best of my knowledge.

Signature

Date

Apply for a Scholarship

Genesis Family Scholarship Foundation

Scholarship Application

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