Grant application form

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For the applicant: Complete the items below. Then forward the link provided on the Human Infusion Project website to your practitioner or therapist for their recommendation. Both forms will need to be completed and received by February 1st, 2024. Grant recipients will be notified by email on or after March 15th, 2024. Awards will be distributed directly to the selected recipients.

Grant requirements:

1. Must have initiated and attended at least 4 sessions (paid or unpaid) by a verifiable therapist or therapeutic practitioner.

2. Must have endorsement by practitioner on client motivation, progress and benefit, provided through separate practitioner referral form ( link provided )

3. Must have financial need.

4. BOTH the individual application and the practitioner endorsement must be received by February 15, 2024 to be considered.

5. If selected, must have bank account or payment venue (Venmo, Paypal ) that can support electronic transfer of funds.

6. If selected, will be asked to submit headshot photo for announcement in community newsletter and on social media business page.

Applicant Information *

First and last name

Email address *

Phone Number (In case of questions) *

City and Country of Residence *

What is your annual household income range (USD) ? *

<$60,000

$60,000 - $90,000

$90,000 - $120,000

greater than $120,000

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