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Howard University's Chadwick Boseman College of Fine Arts Mental Wellness Program
The Boris L. Henson Foundation recognizes during this difficult time that affording the cost to seek services can be a barrier. The Howard University's Chadwick Boseman College of Fine Arts Mental Wellness Program was developed to cover the cost for therapy services by licensed clinicians in our network for up to five (5) sessions. This short-term opportunity is offered to those apart of the Howard University.
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Disclaimer
If you are having thoughts of harming yourself or others, please call 911 or report to your local hospital immediately. This time-limited opportunity is primarily for those experiencing stress or anxiety related to the pandemic OR those impacted directly or indirectly as a result of the injustice and maltreatment observed in the last 30 days.
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Please Select a Provider IN YOUR STATE
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Provider in Your State
DC - Capitol Hill Consortium for Counseling & Consultation
DC - Petrina Williams of Petrina L. Williams LICSW, LCSW-C Miracles In Motion Therapy and Consulting LLC
DC - Miss Montrella Cowan of Montrella Cowan, CEO of Affinity Health Affairs, LLC, Licensed Therapist, Life Coach, Author, and Speaker
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Black or African-American
American Indian or Alaska Native
Latino or Hispanic
Asian
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Other:
What is your Major?
Do you have internet access and a private space for the virtual sessions?
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Yes
No
Currently, do you have medical insurance?
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Yes
No
Have you ever received Mental Health services?
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Yes
No
When were you last seen?
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< Less than 30 days
Between 30 days and 6 months
Between 6 months and 1 year
1 year and 5 years
> Greater than 5 years
Please select your primary concern.
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Worried about classes, grades or receiving degree (College/Graduate)
Concerned about elder family members, friends or others in your life
Feeling a loss of community
Lack of supplies or resources i.e food or housing
Employment and financial instability
Change in self-care activities while at home
Increase in alcohol intake/substances
Feeling silenced or injustice (marginalized or suffering in silence)
Feeling anxious due to current racial injustices towards people of color
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Informed Consent and Participation Agreement - ALL acknowledgments MUST BE CHECKED to process your registration
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I acknowledge by submitting a Mental Wellness Support Program registration, I authorize sharing my registration and its contents (referral) with my chosen provider and/or company. Questions regarding your HIPAA patient rights, responsibilities and/or release of information must be sent to your treating provider, if desired.
I acknowledge and give permission for any and all information associated with my registration to be used by the Boris L Henson Foundation strictly for billing, statistics and quality assurance.
I acknowledge that service fees for special exceptions, insurance copays, no-shows, and referrals to alternate providers agreed upon between me and my provider are NOT covered by the campaign.
I will ensure the mandated Quality of Service Survey is submitted online after EVERY visit.
All boxes must be checked to process your registration.
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