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Preliminary Application

Submit this short form to be put in the queue.

Once it's your turn to move onto the next application stage, we will contact you via email to complete a more comprehensive form. 

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If your application is approved, you will be offered a grant for either fully paid or partially paid clinical counselling.

Birthday
Year
Month
Day
Your current monthly income is
Are you financially responsible for anyone?
Do you have monthly medical expenses? (This includes period products)
Are you a resident of the Metro Vancouver Regional District?
Yes
No
Do you currently already have a Therapist?
No
Yes
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