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Reduced-Rate Counseling Scholarship Application

Thanks for taking the time to apply for a reduced-rate slot. I try to keep as many spaces for reduced-rate counseling available as possible in an effort to make mental health support more accessible.

Please fill out this short application to the best of your ability. You will not need to upload any proof of income/finances documents, this is just for me to get an initial sense of what brings you to counseling.

If I do have space available, I will reach out within two weeks of receiving this form to schedule a free 30-minute Zoom meeting so we can connect, get to know each other a little more, and see if we both think we’re a good fit. If I don't currently have space available, I'll put you on a waitlist and reach out when space opens.

All responses are strictly confidential; I’ll never share your responses or contact information with anybody, and will not use your email or phone for any marketing.

Sincerely,

Porter Eichenlaub

Full Name

Email

Where are you located?

Country and/or State:

What brings you to seek counseling now?

What would a successful counseling experience look like and be like for you?

What is your previous experience with counseling, coaching, or other personal development modalities?

Please briefly describe your financial situation, and why you're seeking reduced-rate counseling.

Thanks for taking the time to fill out this application! I'll get back to you in the next two weeks, or if you're ready, you can Schedule a 30-minute Introduction Call for us to meet and see if we're a good fit for working together.