Counseling Program Application
Thank you for your interest in this program! Please complete this short application and we will contact you soon. Thank you so much!
Your information is transferred through a secure network and kept confidential. Only the Executive Director and the Counselor who will be working with you will review your information. Demographic data will be used in our nonprofit reporting, however your name and personal contact information will remain anonymous from the data.
If you are admitted into the program, you will receive a confirmation email with a link to a short enrollment form with a few questions for you to answer so that we can best serve you. When your enrollment form is completed, then you will receive the Participant Agreement to review and sign. You can see the Participant Agree HERE. You will not be able to move forward with the program if you do not complete the enrollment form and sign the agreement. Please do not submit your application if you know that you will not complete the requirements. Thank you!
Testimonial—
“I had never tried anything like this before. I felt like the constant doing and readiness was the only way of managing. I didn't understand what mindfulness was and it didn't feel culturally relevant. After participating in these sessions, I understand how mindfulness can improve my quality of life and make me more focused and more ready. I also understand how it might be utilized to deal with the stress of racism.”
— Counseling Program Participant