The Cheatcode Foundation x ONE Community Application for Free Therapy Services

The Cheatcode Foundation x ONE Community Application for Free Therapy Services
The Cheatcode Methodology is a proven, brain-based mental strength training system designed to help individuals process trauma, reduce stress, and unlock their full potential. This method blends cutting-edge tools like brainspotting, narrative therapy, and expansion techniques. Originally used by elite athletes, entertainers, and high-performing professionals, this approach is now made accessible to underserved communities through the Cheatcode Foundation—empowering people to heal, grow, and live purpose-driven lives.
Applicant Information
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province
Income Verification
What is Your Annual Income After Taxes?*

Under $30,000$30,001 - $40,000$40,001 - $50,000
Household Number of Dependents*
What is Your Employment Status?*

Full TimePart TimeSelf EmployedUnemployedStudentRetired
Crisis Level Assessment
How would you rate your current level of crisis on a scale from 1-10?*

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Please check any of the following struggles or concerns you are currently experiencing:*

AnxietyDepressionRelationship IssuesFinancial StressWork-Related StressGrief / LossTrauma / PTSDSubstance-Use ConcernsOther
Readiness for Change
Have you utilized therapy services before?*

YesNo
How motivated are you to make changes in your life? (1 = Not motivated at all, 10 = Extremely motivated)*

1

2

3

4

5

6

7

8

9

10

1 is Not motivated at all, 10 is Extremely motivated
What is your primary reason for seeking therapy or life coaching at this time?*
What are your goals for therapy or life coaching?*
Understanding the Impact
How do you believe therapy or coaching will help you achieve your goals?*
If you were to successfully overcome your struggles, how do you envision your life?*
What is the most significant change you want to see in your life?*
Demographic Information (Optional)
Gender
Race/Ethnicity

WhiteBlack or African AmericanHispanic or LatinoAsianNative AmericanMixed RacePrefer Not to SayOther
Language Preference
Session Preferences
Do you have access to a computer or mobile phone with wifi/internet to take virtual sessions?

YesNo
Do you have a gender preference for your clinician?

MaleFemaleNo Preference
For your therapy sessions, what is your preference for time of day?

MorningAfternoonEveningWeekend
Legal & Consent
Acknowledgment of Eligibility*

I confirm that my annual income is under $50,000 after taxes and that I reside in Tennessee.
Consent to Participate in Therapy/Coaching*

I understand that by applying, I am expressing interest in participating in therapy or life coaching services and that this application does not guarantee acceptance into the program.
Privacy Statement*

I acknowledge that the information provided will be used to determine eligibility for the subsidized mental health services program and that my data will be handled in accordance with the foundation's privacy policy.
Signature
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The Cheatcode Foundation x ONE Community Application for Free Therapy Services

Applicant Information

Income Verification

Crisis Level Assessment

Readiness for Change

Understanding the Impact

Demographic Information (Optional)

Session Preferences

Legal & Consent