Payne Avenue Counseling

Prior to completing the following form, please email Abigail Fobanjong at Abigail@groundingwaters.com to obtain your custom scholarship ID number.

Please enter your Scholarship ID*

Forms submitted without ID cannot be processed

Part I

This form is part 1 of 2 for the scholarship application. If you’re awarded a scholarship, part 2 will be given when completing counseling intake paperwork.

The Goal

The goal of the Grounding Waters Scholarship Fund is to offer individuals access to a bundle of high quality counseling services when barriers to accessing counseling prohibit using the services. These counseling services are free to you. Anyone is able to apply for this scholarship as many times as they would like. Preference will be given to new applicants and prior applicants who have used all 12 sessions within 6 months.

1. I am able to keep my appointment times. I understand that continuation in the program requires I have no more than 1 late-notice cancellation (less than 24-hour notice) or no-show.*

YesNoOther

2. I am invested in attending counseling. I am willing to attend 12 sessions within 6 months.*

YesNoOther

3. I agree to my information being kept in a secure database for future scholarship applications.*

YesNoOther

4. I live, work, go to church, or have family that lives in the Payne-Phalen neighborhood of Saint Paul. I am able to provide proof of this connection to the neighborhood.*

YesNoOther

Have you previously received counseling through this scholarship?*

No, I have not received counseling through this scholarship.Yes, I have received counseing through this scholarship.Yes; I completed the 12 counseling sessions within 6 months.Yes and I paused the counseling and did NOT complete the 12 sessions within 6 months.Yes and I forgot to attend some sessions and was not able to complete all 12 sessions within 6 months.

That’s it! Thanks for completing this application. We will be in touch with you soon. Please reach out to Abigail with any questions. Abigail@GroundingWaters.com or 651-246-6067