Scholarship Session Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is for people who are looking to receive a 60-minute support session but are in financial hardship due to a variety of reasons.

If you are in immediate crisis please contact your local help-line:
Canada- Text "Start' to 45645
U.S.- Text 'HOME' to 741741
Australia- 0477 13 11 14

Email *

First and Last Name *

How old are you? *

Under 20

20-30

31-50

51+

What most accurately describes the type of support you're looking for? *

I really want to bounce ideas off of you and get your opinion

I feel stuck with a personal situation and need advice or guidance

I am not sure if I need support or deeper therapy and would like to try this first

I feel paralyzed with shame and need a safe space with a safe person to vent

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms