Counseling Scholarship Application Form : Find Help : Listen to Kids

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Counseling Scholarship Application Form

Our Partner Counseling Providers

Currently, we partner with:

Celebration Hope Center, Metairie, LA
Refuge Eighteen-Two Counseling Agency, Metairie, LA
Restoration Counseling, Mid-City, NOLA

We strive to work with counselors who are trained in Story-Informed Trauma Therapy (SITT) developed by a leading, national trauma expert, Byron Kehler. Some counselors are also trained providers of EMDR therapy, Sand Tray Therapy, Emotionally-Focused Therapy, Emotionally-Focused Family Therapy, Child-Focused Play Therapy, Trauma-Focused CBT, Acceptance Commitment Therapy, & Trust-Based Relational Intervention.

As our Counseling Scholarship program grows, we'll expand our list of partner counseling providers.

Further reading on trauma therapies:

EMDR

Emotionally-Focused Therapy

Sand Tray Therapy

SITT

Our Counseling Scholarships are available as funding allows.

After receiving your request via this form, we'll contact you and walk through the process together.

If funding is available, we'll:

1. connect you to a pre-vetted, qualified counselor of our choice

2. ask you to sign a waiver with the counselor so that Listen to Kids can ask about your attendance

3. ask you to sign our Counseling Scholarship Agreement, which outlines your responsibilities and our responsibilities.

4. approve an initial 10 sessions with your counselor

5. pay for all or part of your counseling fees

After 6 or 7 sessions, we'll evaluate your need for an additional 10 sessions. LTK will work with your counselor and let you know if funding for your scholarship will continue and discuss options to continue or end counseling.

Usually, your Counseling Scholarship contact will be Michelle Scandurro, LTK Founder & President.

If, at any point, the client would like to request a different counselor, we're happy to have that conversation.

Counseling Scholarship Application Form

Counseling Scholarship Application

Name of Scholarship Applicant: (Required)

Age of Scholarship Applicant: (Required)

Referred by: (name of social worker, therapist, institution, or agency who told you about this program) (Required)

Referral Contact Information: phone number or email (Required)

Caregiver/Parent's Name (first & last)

Caregiver/Parent's Phone Number

if applicable

please include area code

Caregiver/Parent's Email Address:

if applicable

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Applicant's Phone Number (Required)

Please include area code.

Applicant's Email Address

What are you hoping to work on in counseling? (Required)

Have you experienced abuse, neglect, or trafficking? (Required)

Please note that the definitions of "abuse" and "trafficking" include the coerced forcing of sexual acts or labor.

Coercion of a minor, even if that minor is willing, is a crime.

Which kind of therapy are you requesting? (Required)

Do you have insurance that could help pay for counseling? (Required)

Do you want to pay for part of your counseling? Fees range from $45 to $135/session, based on the counselor's level of certification and your household income. (Required)

Would you like to request a certain kind of counselor, or even a specific counselor?

female
male
BIPOC (Black, Indigenous, & People of Color)
a specific counselor by name
other request

LTK may not be able to secure a specific counselor for you. However, if you have a strong preference, we'd like to know.

If you checked "specific counselor by name," please give us the name here:

If you checked "specific counselor by name," please provide your preferred counselor's phone number.

If your preference isn't available, are you open to working with another counselor?

If you answered the previous question "no," please explain here:

What days and times are you available for counseling? (Required)

If you have any additional questions about counseling, please add them here.

Would you like to be placed on a waiting list if funding or counselors are not available right now? (Required)

I understand that, if approved, funding is granted exactly ten (10) sessions at a time. The need & funding for additional counseling sessions will be evaluated starting seven (7) weeks after treatment begins.