Therapy Grant Application

Financial assistance for mental health services for individuals under 200% of the federal poverty level

Household Size 200% FPL Annual Income Monthly

1 $31,920 $2,660

2 $43,280 $3,607

3 $54,640 $4,553

4 $66,000 $5,500

5 $77,360 $6,447

6 $88,720 $7,393

7 $100,080 $8,340

8 $111,440 $9,287

For each additional person, add $11,360 to the annual 200% limit.

Address Information

Please provide your current residential address