Trauma Informed Services

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Thank you for taking an interest in the Trauma-Informed Education program. Please take a moment and fill out this form. You have the option to pay for the service in full or make payments before our appointment. Sessions are $50 each.

*Partial scholarship for those that qualify.

*Please Note: Before services can begin. A consultation is required if it's your first time working with us.

***If working with a minor child, parent or caregiver agrees to learn and enter our parenting education program to give the parent the needed awareness, skills, and tools to help their children properly heal from trauma. ***

Email *

Name *

Phone number *

What type of service are you looking for? *

Prevention

Trauma Informed Education/Counseling

Parenting Education

Group Facilitation

Leadership Training

Public Speaking

Domestic Violence Classes

Other:

Best Day to meet *

Mon

Tue

Wed

Thur

Fri

Sat

Morning 11-1pm

Afternoons 2-4

Evening 5-7

If the above times don't work, we can work around your schedule

Reason for seeking support and services. *

If seeking services for a minor are you willing to take our parenting class series to understand the behavior of the child that has experienced trauma. *

Are you in need of a partial scholarship? (Proof of income must be provided. *

Partial scholarship/I'm able to pay a portion of the fee

No scholarship needed. I can pay the fee

Other:

Required

How will you be paying for service? (Zelle or Venmo) If seeking for a scholarship please write what type: Partial or Full Scholarship

Send me a copy of my responses.

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