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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?

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?

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?

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)

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

18. Recent Transcript showing active coursework

19. Internship/Practicum Verification (if applicable)

20. Copy of Associate License (if available)

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: