CA Provider Application
Thank you for agreeing to be a participating provider. You must be licensed to practice in Washington state. We are seeking therapists to aid in assisting Black clients. (If you are in California please use our California provider form)! Licensed, Associate level, and Pre-licensure welcome to apply!

Non Black clinicians who have been trained in anti-racism & racial trauma may be considered. The people’s institute preferably, as we have direct experience with their anti racism training.

At the therapy fund foundation we recognize that the investment for healing has historically been inaccessible to Black folks, largely due to limited providers of color, but also, less resources. WTFF supports our community by offsetting their investment with funding for a total of six (6) session with a pre-approved therapist of their choice (providers are paid $130/ for up to a 60-minute session).

If you are interested in working with us, this is HOW IT WORKS:
1. We will confirm with you all the details you provide in this form (including licensing and malpractice information)
2. Clients must apply for funding and list you as their therapist
3. The client(s) will be notified once approved and provided with 6 voucher numbers. Valid for 90 days
4. You the clinician will also be sent their voucher numbers.
5. Provider will submit a monthly invoice to WA Therapy Fund Foundation HERE: https://forms.gle/zhQ483upRyr4iKQM7
That invoice will include the clients name, voucher #, rate of pay, and the date they were seen.
6. The therapy fund foundation will pay out up to $130 for 6 sessions by paypal, square, EFT, or your own payment processor that you will provide a link for.

Please sign up if you are interested. Or if you know therapists who may be interested, please send them our way. All questions, knowledge, and advice are welcomed! We believe feedback is a gift!

WA Therapy Fund Foundation
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Email *
First & last name *
Phone # *
What is your licence type? *
Required
License # *
If you are an associate level clinician currently under supervision please provide the following information for your supervisor: (Full name, credential #, and a contact # for your supervisor)
If you are an associate please share when you plan to become fully licensed.
Please include a link to your website, therapy for Black girls profile or  psychology today. *
If approved you must have professional liability coverage. Please include the name and policy # below. *
How are you currently providing sessions? *
We understand most providers are working virtual. Please however indicate where your actual business is located. *
How do you identify *
Required
Have you done personal Anti-racist work and feel culturally competent to work with black people without racially retraumatizing them? *
Required
Please share any information you have regarding the anti-racist training you have obtained  and when the training occurred?
Are you accepting new clients? *
Do you work with couples
What are your areas of specialty ? *
Required
If other what areas?
Do you work with children? *
Required
I understand and acknowledge that this is a FREE THERAPY program operated by 90% volunteers.   *
Required
I understand and acknowledge that this is not a paid provider directory. I also understand that updates to my information such as accepting new clients, and other details will not be updated on our website like that of a paid directory. (Those companies are funded with full time staff and use your monthly payments to assist with managing your profiles. We are a nonprofit organization and do not have capacity to consistently make changes to your provider information). *
Do you agree to the terms and conditions, privacy policy, and Provider Agreement? You can find them at the links below. https://therapyfundfoundation.org/provideragreement , https://therapyfundfoundation.org/terms-and-privacy-policy  *
Required
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