Grant Application

Improving your emotional wellness is the best investment you can make in yourself and for the people in your life.

Grants are need based and can fund up to 50% of the cost of online sessions.

Complete and submit the form below. Once we receive your request, we will review the information you provide and let you know if we have any additional questions before making a determination regarding the percent of relief we can provide. Information provided is confidential and will not be shared.

Review times vary, and may take up to 5 business days.

First Name

Last Name

Phone

Date of Birth (m/d/y)

What issues trouble you the most? (check all that apply)

feeling sad

feeling afraid

feeling angry

being easily triggered

feeling emotionally and/or mentally numb

negavtive self-talk

negative thought loops

feeling stuck

feeling hopeless

emotional brain fog

low motivation

psychotic episodes (losing touch with reality)

losing periods of time (unable to remember large gaps of time)

dissociation (feeling seperate from your body)

other

What have you tried in the past for relief of your emotional symptoms?

individual talk therapy

individual online therapy

prescription medication

self-medication (psychoactive substances)

group therapy

help line

EMDR

Tapping

DBT

CPT

somatic therapy

alcohol

drugs

inpatient hospitalization

urgent or emergency services

other

Do you currently experience periods of time where you have visual or sound hallucinations, your thoughts are disturbed or paranoid, or it's difficult to stay grounded in reality?

Yes

Not currently, but I have in the past

How long have you been trying to get help?

less than 12 months

1-5 years

6-10 years

more than 10 years

How have you been feeling lately?

Mostly Overwhelmed

Mostly Good

Do you currently have primary care practitioner?

yes

not currently, but I have in the past

Do you currently have a therapist, counselor, or other mental health professional?

yes

not currently, but I have in the past

What best describes your living situation?

I rent

I own

I am unhoused

Other

What best describes your work situation?

I work full-time

I work multiple jobs

I work part-time

I am unemployed

I am a part-time student

I am a full-time student

Other

What is your combined annual household income?

less than $60,000

$60,000-80,000

$80,000-100,000

100,000-150,000

more than $150,000

How many dependents do you have?

0 1 2 3 4 5 More than 5

Is there any other information about your personal financial situation that we should consider while determining your grant eligibility?

Please upload the first 2 pages of your Form 1040 filed with the IRS last year.

Please upload the first 2 pages of your Form 1040 filed with the IRS the year before last.

I have answered all questions truthfully and to the best of my ability.

True

False

Captcha screen.

Please fill in the comment box below.

Your form has been submitted. We may reach out to you by email or text for clarification if needed.

in lak'ech ala k'in,

Global Trauma Reset

GLOBAL TRAUMA RESET

crisis care

If you need support NOW, text or call

988

crisis care

If you need support NOW, text or call988

If you need support NOW, text or call

988