Sweet Deeds Scholarship Application

Sweet Deeds Scholarship Application
Welcome! Sweet Deeds Foundation works to increase access to quality mental health by reducing financial barriers.

Through a collaboration between like-minded therapists, nonprofits, and donors, we offer significantly discounted rates and financial assistance for those who would otherwise be priced out.

Things to Know
- To be eligible, you must be referred by a Sweet Deeds therapist OR be a current member or client of one of our official partners.
- Funds may only be applied to the cost of therapy with our approved therapists.
- Finanical assistance is for self-pay clients. Those using insurance or whose cost of therapy is being covered by another organization aren't eligible.
- To qualify, your total household income needs to fall within the ranges listed below.
Number in Household / Income Threshold

1 person / $37,650
2 persons / $51,100
3 persons / $64,550
4 persons / $78,000
5 persons / $91,450
6 persons / $104,900
7 persons / $118,350
8 persons / $131,800

Based on 2024 HHS Poverty Guidelines

Privacy

We take your privacy seriously. Your information will be held confidentially and used solely to process your application.
Applicant Information:
Full Name*

PrefixFirst NameLast Name
Mobile No. :*
E-mail :*
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who are you applying for?*

SelfFamily Member (e.g. child)
Name of Family Member(s) You're Applying for:
Household Size. Your household will generally include any dependents or individuals living in your household.
If you are over 18 but claimed as a dependent by your parents/guardians, please provide the household size and income of your parents/guardians.
Household Information. Please list all individuals living in your household, including yourself, using this format: Name / Age / Relationship to You*
Ex. Mike / 35 / Self
Referral Information
If you were referred by a therapist, please indicate their name. Referring therapists must be a part of the Sweet Deeds Network. Write N/A if not applicable.
Are you a member of one of our partner organizations or churches?
Application Questionnaire
We'd like to get a sense of who you are and what your story is. Could you tell us a little bit about yourself?
Could you describe why you are seeking therapy? Do you have any prior experience with therapy?
What is your total household income before taxes per year (including all wages, spouse's salary, housing allowance, other forms of income like child support, Social Security, etc.)?
Income Eligibility

My total household income falls within the thresholds listed for my household size.My total household income does NOT fall within the thresholds for my household size. However, I have extenuating circumstances which I've explained below.I am a college-aged student and financially independent.
Will you be receiving any additional sources of financial assistance for therapy?
If yes, please list source and amount or write N/A (eg. Church Benevolence, $500 total)
Insurance
If you have insurance coverage, we encourage you to see if your plan provides any out-of-network benefits, as these can be substantial.
Income Verification

To complete your application, please provide ONE of the following proofs of income: W2 or 1040 or 2 months bank statements. If you do not have these documents, please indicate in the comments box below.
Cancelof
Comments or Questions. If applicable, use this box to share any extenuating financial circumstances. Is there anything else you'd like to share with us?
Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Sweet Deeds Scholarship Application

Applicant Information:

Referral Information

Application Questionnaire

Income Verification

Applicant's E-Signature