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Apply for Discount

Mentalyc Prelicensure Scholarship Application

Special Offer: Upon approval of your application, get access to all Mentalyc features for just $19.99 a month!

1. Full name

*

2. Email

*

3. Phone number

*

4. Mailing Address:

*

*

*

*

Educational Information:

*

5. Name of Institution:

6. Degree Program (e.g., M.A., M.S., Ph.D.):

*

7. Program Specialization:

*

8. Expected Graduation Date:

*

Prelicensure Status:

9. Are you currently enrolled in a practicum or internship?

*

9. Are you currently enrolled in a practicum or internship?

Yes

No

10. Do you have an associate or intern license from your state's board or regulatory agency for therapists?

*

10. Do you have an associate or intern license from your state's board or regulatory agency for therapists?

Yes

No

Therapy Hours:

11. On average, how many hours of therapy do you provide each week? (hours/week)

*

12. How many clinical hours are required for your licensure? (hours)

*

13. How many clinical hours have you already completed?

*

14. In what settings do you provide therapy?

*

14. In what settings do you provide therapy?

Private practice

Hospital

Community Clinic

Others

Motivation and Contribution:

15. Why are you interested in using Mentalyc for your therapeutic practice? Please describe in your own words:

*

16. How do you plan to contribute to Mentalyc in exchange for this discounted price? (Tick all that apply)

*

16. How do you plan to contribute to Mentalyc in exchange for this discounted price? (Tick all that apply)

Provide regular feedback on software features and usability.

Actively participate in beta testing for new features.

Refer fellow prelicensed therapists and peers to Mentalyc.

Share my success stories using Mentalyc (without violating patient confidentiality).

Required Documents:

Please attach the following documents with your application.

(Please ensure the documents are legible and only attach PDF, JPG, or PNG files. Ensure no personal identification numbers or sensitive information is visible)

17. Enrollment Letter from your institution

*

Size limit: 10 MB

18. Recent Transcript showing active coursework

*

Size limit: 10 MB

19. Internship/Practicum Verification (if applicable)

Size limit: 10 MB

20. Copy of Associate License (if available)

Size limit: 10 MB

Declaration:

*

I, hereby declare that all the information provided above is accurate and true to the best of my knowledge. I understand that providing false information and/or not complying with the above exchange and contribution to Mentalyc, may lead to the cancellation of the Mentalyc Prelicensure Scholarship and potential future ineligibility.

Declaration:

I AGREE

I DISAGREE