scholarship application FORM
Harbor Christian Counseling provides a standard sliding fee scale that is meant to accommodate the vast majority of financial situations. In certain cases, individuals or families with acute financial limitations may apply to receive scholarship support for counseling services. These funds have been generously donated by our community partners through our 501c3 organization, Harbor Christian Partnership.
To request scholarship support for counseling services, please submit this application in full prior to your initial appointment. Your application will be reviewed by Harbor Christian Partnership directors. Allocation of scholarship funds will be based by a variety of factors, including availability of funds and volume of requests, and is not guaranteed.
You will be asked to include a copy of your most recent pay stub, tax return summary, or other income information to verify the information below. Please note that your information will remain confidential, will be stored securely, and will be deleted after your request has been fully processed.
Harbor Christian Partnership Scholarship policies:
The following terms and conditions are implemented to ensure responsible stewardship and allocation of charitable donations given our community partners.
The financial agreement form will specify the number of sessions authorized for scholarship. In most cases, the number of authorized scholarship sessions is final and cannot be extended. In some limited circumstances, Harbor Christian Partnership (HCP) may reassess this agreement in order to determine whether any ongoing scholarship support can be provided. This decision will be based on a variety of factors, including the availability of funds, waitlist status, acuity of symptoms, prior engagement with services, changes to the recipient’s financial status, and alternative treatment or aftercare options. Ongoing authorization of scholarship funds cannot be guaranteed.
All standard HCP fee and cancellation policies apply to scholarship recipients. Late cancellations (less than 48 hours prior to scheduled appointment) and no shows will be charged the full co-pay amount as stipulated in the “Financial Agreement Form.” Limited exceptions will be made on a case-by-case basis for sudden illnesses and emergencies.
Multiple cancellations (more than two) will prompt an internal review of the scholarship arrangement. Three consecutive late cancellations or no shows will prompt immediate remittance of scholarship.
Full payment of copay is due at the end of the day for each appointment. Failure to provide copay for two or more sessions will prompt internal review of the scholarship agreement and will result in temporary inability to schedule subsequent appointments until the overdue balance is paid.