Organizations Scholarship Program Application

Start an Organizational Scholarship Program

To start your organization’s scholarship program simply complete the online application below and electronically sign the Scholarship Program Agreement you’ll be taken to at the end of the application form.

Organization Information
Your Organization's Name*
Name
Your Organization's Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Organization's Website
Organization Contact Person
Name*
First Last
Phone*
Email*
Enter Email Confirm Email
Authorized Signer*
- I warrant that I am authorized to enter the above identified organization into a scholarship agreement.
Which type of scholarship program do you wish to establish?*
- A Direct Scholarship Program – we debit your account each week for after each counseling session you scholarshipped the week prior
- A Managed Scholarship Program – you contribute an initial amount to your scholarship fund, and we debit the fund for each scholarshipped counseling session
Scholarship Funding
Your Prefered Funding Schedule For Your Managed Scholarship Program*
- Monthly Contributions
- Annual Contributions
- One Time Contribution – Then As-Needed
Initial Contribution Amount
Please indicate the dollar amount you would like to regularly contribute to your Managed Scholarship Program. MyCounselor will automatically debit this amount according to the frequency you selected above. Funding amounts can be changed at any time. MyCounselor recommends contributing at least $500/month per 200 constituents in an organization. Funding amounts can be changed at any time.
Total
$0.00
Credit Card
Card Details
Cardholder Name
Bank Transfer Authorization*
A member of our team will reach out to your organization by phone to obtain your banking account and routing number.
- I authorize this bank account to be electronically debit. I acknowledge that electronic debits against the account must comply with United States law. This payment authorization is to remain in effect until I notify MyCounselor.Online of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.

Organizations Scholarship Program Application

Start an Organizational Scholarship Program

Organization Information

Organization Contact Person

Scholarship Funding