This is the beginning of the application process for a
HOPE Mental Health Sponsorship.
If you are in immediate need for help or in crisis please CLICK HERE
It could take up to 6 weeks to receive a response on your application.
The application committee meets on the first Wednesday of every month to go over applications received from the month prior. You can expect to receive a response to your application within 5-10 business days of the first Wednesday of the month following the date of your application submission.
**Please submit your application PRIOR to the last day of the month to ensure your application will be reviewed at the next meeting. Applications received in January are looked over in February. Applications received in February are looked over in March, etc. **
THE FOUNDATION CAN NOT PROVIDE FUNDS FOR SERVICES THAT TAKE PLACE PRIOR TO YOUR AWARD DATE.
2022 Application Review Dates:
ANY SESSION COSTS YOU
INCUR DURING THE WAITING
PERIOD WILL BE
This application is completely confidential
We strive to keep your information private. We use HIPAA compliant software and in an extra effort to provide anonymity and neutrality some identifying information will be removed from your application when it goes to the committee for approval.
This looks to be a minor. Please provide your contact information below.
THIS SECTION IS ONLY REFERRING TO
MONTHLY INCOME AND EXPENSES.
IF YOU PUT DOWN ANNUAL AMOUNTS YOUR APPLICATION WILL BE SENT BACK TO YOU FOR REVIEW.
Please fill out the worksheet below with your best estimate of expenses for the household of the applicant or the guardian of the applicant. We understand that sometimes these numbers can fluctuate. Some expenses may change seasonally. In those categories, please put in the AVERAGE monthly cost.
If there is a category that is not applicable please put a ZERO (0) in that column.
PLEASE MAKE SURE THAT THE AMOUNT IN THE BOX ABOVE IS ACCURATE TO WHAT YOU HAVE LEFT OVER AT EVERY MONTH.
This final section is about your current or chosen counselor.
It is VERY IMPORTANT that the information you provide in the next section is accurate
If you are approved for a sponsorship, your award amount may be based on the information you provide in the next section.
You will need the following information:
Inaccurate or incomplete information could result in your application being denied.
If you do not have this information available to you right now please save your application and come back to it after speaking with your therapist or their office and obtaining this information.
*you only need to provide this information for the services you are seeking financial assistance for.
Please do not continue with this application until you have accurate information about your therapist and their rates.
Please do not continue with this application until you have accurate information about your group and the rates for the program.
Search for the license number of your counselor on the
ARIZONA STATE BOARD OF BEHAVIORAL HEALTH EXAMINERS.
PLEASE PROVIDE ACCURATE RATE AMOUNTS for your therapist or program.
If you do not know their FULL RATE please call or email your counselor and get this information before submitting your application.