Hardship Fund List

1

Name

First Name

Last Name

2

Phone Number

Please enter a valid phone number.

3

Email

example@example.com

4

Do you want to receive regular massage therapy but cannot afford it?

YESNO

5

Would you be willing to commit to paying a set discounted rate?

YESNO

6

Are you seeking massage therapy to help manage a specific health condition or overall healthcare plan?

Yes, to manage a chronic pain or medical condition (e.g., arthritis, fibromyalgia, neuropathy)

Yes, as part of injury recovery or post-surgery rehabilitation

Yes, for mental health management (e.g., anxiety, PTSD, high stress, sleep disorders)

Yes, as recommended by a physician or healthcare provider

Preventive care / overall wellness

Other

7

Why should you be awarded a scholarship to receive regular massage therapy?

Managing chronic pain or physical mobility

Reducing mental health strain, stress, or trauma

Supporting recovery to return to work or daily activities

Lowering out-of-pocket medical expenses

Other

8

In 2–4 sentences, please share your story and why this scholarship is important to you right now.