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  • Sonoma County Black Forum Black Therapy Application

    Sonoma County Black Forum Black Therapy Application

    The Sonoma County Black Forum Black Therapy Fund Voucher Program offers up to 12 sessions of mental health counseling, from culturally competent therapists, for up to 234 qualifying Sonoma County Residents. Each session is valued at $150 per session. This funding is being supported in whole by federal award number SLFRP0246 awarded to the County of Sonoma by the U.S. Department of the Treasury through the American Rescue Plan Act of 2021. The Sonoma County Black Therapy Fund program is administered by Sonoma County Black Forum.
  • ATTENTION: This application is only for the Black Therapy Fund and NOT THE FINANCIAL ASSISTANCE PROGRAM. If you are seeking Mental Health support, please continue. If you are seeking financial assistance, stop and do not fill out this application. The Financial Assistance Program is unable to accept new applications as of Friday, February 10, 2023.

     

  • What Services Do Vouchers Cover?

    Mental Health Services in-person or via telemedicine. Although you and your provider will determine how many sessions you need, this program will provide a total of 12 sessions. Participants will be provided a list of partner therapists. Once a provider has been selected, participates are responsible for scheduling initial consultations and follow up therapy sessions.
  • Do I qualify for a voucher?

    Are you experiencing mental health challenges/issues? You qualify. Are you in need of mental health support? You qualify. Need funding support to cover costs of services? You qualify. Applicants must be current Sonoma County residents (minimum 6 continuous months). The Sonoma County Black Forum will not deny assistance to an otherwise eligible household on the basis of race, ethnicity, gender, sexual orientation, or religion. This program is open to all Sonoma County residents regardless of immigration status. Sonoma County Black Forum will not require applicants to state their immigration status.
  • Who Will See My Information

    Applicant information provided in the application process will be kept confidential, and helps us determine eligibility for program participation. Demographic data may be anonymously used to seek potential grant funding to support our future programs or to extend current funding. For information addressing concerns about disclosure of Personal Identifiable information in ARPA Community Resilience Program Data Reporting, please click on the Data Collection and Release of Information link below.
  • Data Collection and Release of Information English

    Recopilación de Datos y Divulgación de Información en Español

    Data Collection and Release of Information English (Minors)

    Recopilación de Datos y Divulgación de Información Español (Niños)

     

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  • Application

    Please provide the information below to participate in the Sonoma County Black Forum Black Therapy Voucher Program. Your information will be kept confidential, and helps us determine eligibility for program participation. Demographic data may be anonymously used to seek potential grant funding to support our future programs or to extend current funding.
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  • Please upload your current lease/rental agreement or other current forms of Documentation below, such as rent receipts, cancelled checks or money orders, utility bills, etc. TWO CURRENT DOCUMENTS ARE REQUIRED. In order for your application to be reviewed, it must include two current documents with your first and last name on them.

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  • Demographic Questions

    Applicant information provided in the application process will be kept confidential, and helps us determine eligibility for program participation.  Demographic data may be anonymously used to seek potential grant funding to support our future programs or to extend current funding. Individual data may be aggregated into anonymous group data for use in public reports and to fulfill equity standards for ARPA funding that is required by the federal government. Sonoma County Black Forum will not deny assistance to an otherwise eligible household on the basis of race, ethnicity, gender, sexual orientation, or religion.
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  • Session Cancellation Policy

    *You must contact your therapist 48 hours prior to your scheduled appointment to cancel or the Sonoma County Black Forum will be charged for a full session.
  • Consent

    By submitting my application for the Sonoma County Black Therapy Fund (SCBTF), I consent to the following:
  • I permit SCBTF partner Mental Health Providers to communicate and share basic personal data in compliance with ARPA data collection requirements. This data will include participant name, contact information, the number of sessions provided, administrative assistance with scheduling, referral agency and participant surveys. I understand that SCBTF, Sonoma County Black Forum, and its community partners will not access any HIPAA protected, personal and/or confidential information related to services provided by Partner Mental Health Providers and their clients, but are acting solely in an administrative and referral capacity.

  • Post Assessment Survey Request

    To document the effectiveness of the program and to ensure future funding of this program, we invite you to complete an anonymous brief Post Assessment Surveys (PAS) at the conclusion of your therapy sessions. In appreciation of completing our brief survey, you will receive $25.00.
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