• Hope to Alaska Application

    We’re so glad you’ve taken the courageous step to seek support. Hope to Alaska exists to provide financial assistance for individuals pursuing counseling. While Hope to Alaska does not provide counseling directly, we partner with trusted mental health providers throughout the local community who offer care to our applicants. Each provider in our network completes a thorough vetting process that includes an application, background check, reference checks, and an interview. Our goal is to ensure every applicant is connected with a qualified and compassionate mental health professional. We’re honored to walk alongside you on this journey and look forward to connecting with you soon.

  • What to expect when you apply

    Please note that it may take several weeks to complete the review and authorization of your application. Once funding becomes available, our Hope to Alaska Coordinator will contact you by both phone and email. If you have questions about the status of your application, you’re welcome to email us at hopetoalaska@acfak.org. Applications are valid for 90 days after you are contacted by a Hope to Alaska Coordinator once funding becomes available for you. If the 90-day period expires, a new application will need to be completed. Thank you for your patience. If you currently have health insurance and would like help locating a provider, please select "Information Only". We’re happy to share a list of providers and practices within our network to help you get started.

  • Are your currently having self-harm thoughts?

    If you are currently experiencing thoughts of harming yourself or someone else, please go to the nearest emergency room or call 911 immediately. You can also call or text the National Suicide & Crisis Lifeline at 988 for immediate support.
  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you filling this form out for yourself or a minor child?*
  • Have you or your minor child received support from Hope to Alaska in the past?
  • Are you currently in counseling and requesting additional appointments?
  • How many times have you received support through Hope to Alaska
  • Format: (000) 000-0000.
  • What is your age or age of minor child?*
  • What is your date of birth or date of birth of minor child?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • What is your marital status? If you are filling this form out for a minor child please select "minor".*
  • Current living status of minor child*
  • What is your gender or the gender of the minor child?*
  • Which race or ethnicity best describes you or your minor child? (Please choose only one.)*
  • Where did you hear about Hope to Alaska?*
  • What area of Alaska do you live?*
  • Please choose the practice you would where you would like to be seen. If you do not know, select Unsure. If you are looking for contact information for providers in our Referral Network select Information Only. Our Hope to Alaska Coordinator will still give you a call to help connect you with resources.*
  • What type of therapy are you looking for? You can choose more than one type of therapy.*
  • Please select what concerns/issues you are looking for to address in counseling. You can select as many as apply to you.*
  • Should be Empty: