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Home
Who We Are
Our Vision, Mission, Core Values
Our Story
Our Manifesto
SSL Day
Board & Staff
Past Oversight Board & Board Members
FAQ
What We Do
Project Women EMPOWERMENT
Heidi Dennis Wonder Woman Scholarship & LIFT Mentorship Program
Empowerment and Leadership Conferences, Workshops, Retreats
COVID-19 Response – Women
Project Kids
John & Elizabeth’s Annual Toy Drive
History of the Annual John & Elizabeth’s Toy Drive
RISE
COVID-19 Response – Kids
Get Involved
Donate
Become A Member
Become a Mentor
Become a Sponsor
Become a Volunteer
Events
Media
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In the News
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Contact
Counseling Grant Program Application
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Counseling Grant Program Application
Name
(Required)
First
Last
Date of Birth:
(Required)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
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31
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
(Required)
Marital Status
(Required)
Single
Married
Widow
Domestic Partner
Email
(Required)
Last employer
(Required)
Date of last employment
(Required)
Do you currently have health insurance including COBRA?
(Required)
Yes
No
Number of Household members
(Required)
Household income before COVID-19
(Required)
Household Income after COVID-19
(Required)
Reason for requesting therapy
(Required)
Do you currently have a therapist?
(Required)
No
Yes
If yes, who is your therapist?
Is there anything else that you would like to share about your current situation that would help us to better understand your need?
By applying for this grant, I acknowledge:
That the above information that I provided is true and correct.
Sessions are limited to no more than 5 per applicant.
The funds from Project HOPE may only be used for the mental health services provided by an SSL vetted and approved licensed mental health professional.
Once accepted and grant funds are awarded from the Project Hope Program:
Must be started within a couple of weeks from date of acceptance and completed within 60 days.
That I have read and accept the terms and conditions of the
SSL Foundation Responsibility and Disclaimer:
The processing and review of applications, and determinations regarding awards and payments of grants, are subject to the
sole and absolute discretion
of the SSL Foundation. Applicants must acknowledge that grant funds will be awarded by SSL in its sole discretion and without recourse to the SSL Foundation regarding any determinations, funding decisions, awards, payments, mental health services or other matters related to or arising out of the SSL Foundation’s Project Hope Grant Program and applications will include a waiver and hold harmless/indemnity provision.
SSL Foundation reserves the right to modify, suspend or terminate the Project Hope Grant Program at any time.
Grant Payments: SSL Foundation will notify the applicant of acceptance into the Project Hope program.
Grant recipients will be provided with a referral to a vetted and approved mental health professional.SSL Foundation will disburse funds to the providing therapist once appropriate documentation has been received by SSL Foundation.
Individual grants hold no monetary value and may not be transferred.
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