Margaret Phillips Youth Mental Health Empowerment Scholarship Youth Scholarship Information **Please read through scholarship information before completing application**Child's full name First Last Child's ageChild's gender Female Male Non-Binary Choose not to answer Child's school name Parent/Guardian’s full name First Last Relationship to the child Parent/Guardian Email Parent/Guardian Phone numberEstimated household incomeNumber of dependentsDo you currently receive any government assistance (welfare, food stamps, etc.)? Yes No Is your child between the ages of 13 and 17? Yes No Do we have consent from parents or caregivers to receive mental health treatment? Yes No Can you commit to treatment in person or over telehealth for a minimum of 6 sessions? Yes No Can you commit to participation based off the counselor’s recommendations for treatment? Yes No Can we contact you for more information? Yes No Please provide a detailed explanation of why your adolescent requires therapy and why you are seeking the scholarship.Adolescents must submit a 500-word essay or creative expression that reflects their personal experiences, challenges, and how they envision the scholarship will empower them to enhance their mental health and well-being. Submit here or email to [email protected]Max. file size: 35 MB.By submitting this application, you certify that the information provided is accurate and complete to the best of your knowledge. You understand that this scholarship is granted based on financial need and the child's therapeutic requirements. 47257Δ
