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Advance Hope Ministries Scholarship Application

This application is requesting financial support in the form of a scholarship for mental health services for those with a financial need and have a financial barrier to receive services. Scholarships are based on a sliding scale fee determined by your income. Scholarship funds are not guaranteed and depend on available funds for distribution.

Scholarships are provided through donations from generous donors that believe in coaching or counseling from a Christian worldview. Scholarship funds will be provided for individuals and paid directly to Mental Health providers that register with the Advance Hope Ministries network.

A release of information will need to be signed on approved scholarships between AHM and the Mental Health Provider to share dates of service.

Personal Details for Individual Requesting Scholarship

Is this application for individual, couple or family services?
Is this an application for a minor?
How did you hear about this Advance Hope Ministries Scholarship?
Have you ever received a scholarship from Advance Hope?
Do you attend Church?
Do you have health insurance or an HSA?
Tell us about your work?
Are you a student?
Do you live with a disability?
Are you a veteran?
Please tell us about your housing:
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Do you currently have a Mental Health Provider not listed above? (Counselor, Coach, etc.)
If you qualify for a AHM scholarship all payments will be sent directly to your Provider. Your provider will need to register with us so we know who to pay. Do you authorize us to send a letter of decision to your provider?

By signing below you are acknowledging that you are providing accurate information about your life and your finances. You also acknowledge you are pursuing a scholarship for counseling or coaching through a faith-based provider.  Please note that filling out this application does not guarantee approval and a decision letter may take 2 to 3 weeks.  Please note decision letters will be emailed to the applicant.

By signing below, you are requesting your information to be reviewed by AHM and a scholarship committee. Additionally, by signing below, you are allowing AHM to contact your mental health provider and provide them with a link to participate in our scholarship program. Providers must be registered to receive funds.

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