Mental Health Funding Application

Please tell us a bit about you and how we can support you.

First Name

Last Name

Phone Number

Address

Pronouns

What type of support are you looking to have funded? (ex. Therapy, Coaching, Energy Healing, Gym Membership)

Please tell us a little bit about yourself and why this funding would help you.

Which applies to your circumstances?

I have a practitioner/business that I would like to use

I need help finding the right service for me

If you have a practitioner in mind, please provide their website, email, phone number (if applicable) and business address. Alternatively you can have them email this information to hello@oneinfiveproject.com

By checking this box I acknowledge I am being added to a list of applicants. I understand the funding I receive will be sent directly to the mental health practitioner.