Application for Assistance

If you have been a victim of sexual misbehavior and require assistance to pay for counseling or if you are in need of addiction support counseling and lack the financial resources to participate, please email the following information directly to hartforhealing@gmail.com.

Email your:

Last Name and First Initial

Email Address

Phone Number

State Your Economic Need for Counseling

What Agency, Clinician and Phone Number Do You Hope To Receive Counseling From?