THERAPY FOR BLACK FOLX- CLIENT APPLICATION
Email *
THERAPY FUND FOR BLACK FOLX: CLIENT INTEREST FORM
As a Black or Brown person, do you feel like it is impossble to heal during these extraordinary times of continuous violence, prejudice, discrimination, and inhumane acts against people that look like you? Well, you are not alone.
 
Despite the glaring needs of Black Folx, only 1 in 3 Black people who need mental health care actually receive it. One study showed that 63% of Black people believe that a mental health condition is a sign of personal weakness. Contrary to this belief, it takes courage, not weakness, to take action toward our own emotional wellbeing.

Gena Golden, LCSW created this fund to center healing as a liberatory response to inequitable treatment, generational trauma and the persistant psychological wounds inflicted upon the body, mind and spirit of Black folx.

The Therapy Fund for Black Folx seeks to provide 4-6 therapy sessions provided by licensed and experienced mental health professionals who embody cultural humility, anti-oppressive treatment methods and prioritize the healing of Black Folx.
Your email will be recorded when you submit this form.

If you are uninsured, underinsured, or facing a financial challenge, your application will be welcomed here.
Please note: Your submission does not guarantee immediate approval. Funds are available on a first come, first served basis, and funds remain available until they are committed or exhausted.  
HOW IT WORKS
* If funds are available, you may be approved for up to 6 sessions {there is a limit of 6 vouchers per year}
* You will be provided with a unique voucher number per session {vouchers are not transferrable and will expire if not used within 60 days}.
* You will select an approved therapist from the directory {enrolling to the therapist directory does not make us partners or affilates and we are not liable to any harm done to either the client or the therapist}.
* You will schedule an appointment with the therapist of your choice {we encourage clients to do their due diligence to ensure good fit}.
* You have 60 days to utilize voucher or run the risk of it expiring.
* You will present the voucher(s) to the therapist after scheduling for an appointment.
What is your full name? (Last, First) *
How old are you? *
What is your racial identity? *
What is your gender identity? *
What is your primary reason for seeking the service? *
How did you hear about us? *
Required
AGREEMENTS AND ACKNOWLEDGEMENTS
By checking "Agree," I certify that I am not having thoughts of harming myself or others, but if I do have these thoughts, I will dial 911 or 1-800-273-8255 for the National Crisis Hotline. *
I acknowledge that my submission does not guarantee immediate approval. Funds are available on a first come, first served basis, and will remain available until they are committed or exhausted. *
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