The Healing Quotient: Healing Grant Application

The Healing Quotient's vision is to help create a world where anyone recovering from trauma has access to the clinical & somatic therapy they need to heal and thrive. 

On behalf of the Healing Quotient team, we'd like to acknowledge your bravery and commitment to walking your healing path. 

You are invited to tune into your intuition and feel into what feels relevant for you to share. If you feel that you do not want to answer a question, you can absolutely pass it. We do not read these applications looking for details, rather we use any information you choose to share with us to help us allocate funds and provide any additional assistance we may be able to. 

We are also not judging any kind of writing - feel free to use bullet points/be as straightforward as you wish. We know these are not easy questions to answer and we appreciate your effort and time. 

Applications are reviewed monthly during the first half of the month, and applicants are notified of services available to them during the second half of the month.

Please note we cannot guarantee a healing grant to all who apply, and we cannot guarantee we can grant the amount you are requesting (if you are not applying with a specific amount, that is okay too). With that said we will do our best to provide some type of support. 

If you are completing this application for someone else (a child, a client, etc), please complete the items below as they apply to the person seeking treatment, NOT the person completing the form. If you are a provider completing this form for a client, please submit the contact information of the client or family of the client you are completing this application for - there is a place where you can share your own contact information in the end of the application.
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What is your full name?
What are your preferred pronouns?
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Select the option(s) below that best reflect your racial identity:*
Clear selection
Ethnic Identity (For example, Persian, Native Hawaiian, Afro-Caribbean, Malaysian Chinese, etc):
What Healing Quotient services are you applying for:
The best email to reach you at:
How did you hear about The Healing Quotient?
Financial Overview
The questions below will help us understand what type of financial resources we can provide. 
What is your individual annual income before taxes?
If you have listed your income as $0/year, please share how you currently obtain housing and necessities such as food, transportation, utility bills, medications, etc.
Is there anything else you would like us to know about your financial situation?
Trauma Recovery Needs Assessment
The questions below will help us understand what type of trauma recovery assistance you are looking for. Please provide us with as much detail as you feel comfortable with. 
Deep breath check #1 
Take a deep breath in and out, you are doing a great job.
Please describe the type of trauma recovery support you are seeking. Eg) If you already have an idea of what you would use the Healing Grant for, please share that with us here.
Please describe what is preventing you from receiving the support you are seeking:
Please describe what your goals are in regards to your healing path:
Please describe what supports you are putting in place to help you reach your current healing goals? What are some of your strengths? Or practices you are currently practicing (yoga, meditation, singing, dancing etc)?
Do you have a support system you feel you can rely on?
Are you looking for assistance with finding healing modalities that may help with what you are experiencing? If no, you can skip this question. If yes, please share anything about what you are experiencing that may help our trauma recovery specialist with making recommendations.  
How much would three months worth of your desired trauma recovery treatment cost? Don't worry if this is unknown, we can help with calculating that. 
Current Providers
The questions below will help us understand what type of supports you currently have. Please provide us with as much detail as you feel comfortable with.
Deep Breath Check #2 

How are your shoulders and neck feeling? Perhaps take a few slow shoulder rolls, tilt your head side to side, and take three more deep breaths in through your nose and out through your mouth.
Clear selection
Are you currently seeing a mental health professional (therapist/psychiatrist) or receiving any other form of care/support (family/somatic work/etc)?
Please share any diagnoses that feel relevant to share and note that this question is completely optional.
Only complete the following section if you are completing this form on behalf of someone else. 
If you are completing this form for someone else, please complete the items below as they apply to yourself, NOT the person seeking treatment.
Full Name
Relationship to Applicant
Email
Thank you for your time and trust.
We understand this may have felt like a lot, and we are grateful for your insights. 
Is there is anything else you feel you'd like us to know? If yes, please share below.
Deep Breath Check #3 
You did it. Take a deep breath innnnn and sigh it outtttt. 

Take a moment to ask yourself what one word or phrase you need to hear most right now. And breathe that in. 

If you'd like to share it, write it below three times in a row:
Submit
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