Scholarship Application
Thank you for your interest in the Akin Family Program. We understand that mental illness affects families of all kinds. Our scholarship program is here to support those who want to participate but aren't able to pay the full monthly price. Each month we admit a select number of participants at reduced or no charge.

Please submit the information requested in this form and we will get back to you about your eligibility for the program as soon as possible.

Note that we review responses to this form weekly on Monday's and allocate new scholarships on the first Monday of each month. If you do not hear from us, it means you are still in the queue. Please be sure that you submit an email address that you check regularly.
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Email address: *
Please use the same email address as the free account that you created on the Akin website.
What are you looking to gain from participating in the Akin Family Program?  *
What is your health insurance status? *
What is your total annual household income? *
Which parts of the Akin program are you interested in? *
What price can you afford for the program? *
If selected, would you be willing to participate in providing additional feedback about the program through surveys and/or interviews with Akin staff?
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Anything else that you would like to share?
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