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  • 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 

     

  • What you can expect in the application process:

  • 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. **

     

    Please note:

    THE FOUNDATION CAN NOT PROVIDE FUNDS FOR SERVICES THAT TAKE PLACE PRIOR TO YOUR AWARD DATE. 

  • 2022 Application Review Dates: 

    February 2nd

    March 2th

    April 1st

    May 4th

    June 8th

    July 6th

    August 3rd

    September 7th 

    October 5th

    November 2nd

    December 7th

     

  • ANY SESSION COSTS YOU

    INCUR DURING THE WAITING

    PERIOD WILL BE

    YOUR RESPONSIBILITY

  • 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.

  •  -  -
    Pick a Date

  • This looks to be a minor. Please provide your contact information below. 

  • Applicant Demographic Information

    This page will include questions regarding general demographics for the applicant, unless otherwise stated. All questions are required.

  • Military Service

    This page will include questions regarding any military service for the applicant or closely related family members of the applicant. (Closely related family members are members of your immediate family, such as spouse/partner, parents and siblings.) All questions are required.

  • First Responder

    This page will include questions regarding any employment as a first responder for the applicant or closely related family members of the applicant. (Closely related family members are members of your immediate family, such as spouse/partner, parents and siblings.) All questions are required.

  • Education

    This section will ask about the applicant, or the guardian of the applicant's, education.

  • Employment

    This section will ask questions about the applicant, or the guardian of the applicant's employment and benefits.

  • Income

    This section will go over the household income of the applicant, or guardian of the applicant. This section should include all contributing household members incomes & expenses. Supporting documentation may be requested after the application has been received.

  •  

    ----MONTHLY----

     

    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. 

  • Counseling

    This section will ask questions about any mental health experience the applicant has had in the past or currently. Including former and current counselors and diagnoses, if applicable.

  • 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:

    • Your therapists name & credentials
    • Your therapists place of business, address, phone number and email address
    • The cost of a session with your chosen counselor*
    • The MONTHLY cost of your group program*
    • The number of times you attend counseling per month*
    • The number of times you attend group therapy per month*

     

    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. 

  • About your counselor

    In this section we will be asking you questions about the counselor you (the applicant) are currently seeing

  • 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. 

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