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My Account
About
Janesse Russel
Work With Me
Services for Adults
Creative Recovery Program
Services for Teens
Speaking Engagements
Blog
Contact
Sign In
My Account
About
Janesse Russel
Work With Me
Services for Adults
Creative Recovery Program
Services for Teens
Speaking Engagements
Blog
Contact
Please complete the form below to be considered for A partial scholarship (sliding scale):
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
How did you hear about me?
*
Are you currently employed?
*
Sliding Scale offers and scholarships can range depending on your lifestyle and economic hardship. Select the option that best fits your employment status now.
Not Employed
Self-Employed
Part-Time
Full-Time
Social Security/Disability
What types of services are you interested in?
*
Check all that apply.
Creative Recovery Program: Group
Creative Recovery Program: Individual
What is your household's annual income?
*
$0-$20,000
$20-$50,000
$50,000-$80,000
$80,000+
How have financial barriers or economic hardships kept you from getting the healing that you need?
Is there anything else I should know about your situation?
What is the best way to reach you?
Email
Phone Call
Text Message
Thank you!
