Affinity Holistic Living Mental Wellness Fund 2022: Apply for Therapy

The Holistic Living Mental Wellness Fund provides financial assistance to Black LGBTQ+ people to increase access to mental health support. Through this program we offer financial assistance to Black LGBTQ+ individuals who are experiencing financial hardship to access mental health services from providers with shared identities.

Use this form to sign up to apply for financial assistance for eight therapy sessions with one of our Partner Therapists.

Click here to review Partner Therapist.

Applications will be accepted for a first come, first serve basis.

Affinity Community Services is a Black led, queer led organization on Chicago’s Southside dedicated to social justice in Black LGBTQ+ communities. For 25 years, we have centered Black queer women through community organizing, intergenerational programming, education, and healing justice.

Learn more at affinity95.org

Do you live in Illinois?

This program is only available to people living in Illinois.

Yes

Name

First Name

Last Name

What pronouns do like people to use when referring to you?

She/ Her

He/Him

They/Them

None

Other

Other Pronoun:

If the pronouns you like people to use for you were not listed above, please include them here

Verify Email

Phone

Do you have a preferred method of contact?

(check all that apply)

E-mail

Phone

Do you identify your race/ethnicity as Black/African-American?

Yes

Are you currently in need of mental health services?

Yes

Is your current financial situation preventing you from accessing the mental health services you need?

Yes

Gender Identity

Please select the term(s) that best represent how you identity in terms of gender.

Transgender Woman/ Feminine

Transgender Man/ Masculine

Non-Binary/ Gender-Fluid

Cisgender Woman

Cisgender Man

Other

Other Gender Identity

If the term(s) for gender identity you use for yourself were not listed above, please include them here

Sexual Identity

Please select the term(s) that best represent how you identity in terms of sexuality.

Lesbian

Gay

Queer

Asexual

Heterosexual

Other

Other Sexuality Identity

If the term(s) for sexual identity you use for yourself were not listed above, please include them here