Financial Support Pre-Screening ApplicationΔChild's First NameChild's AgeParent or Guardian's First NameParent or Guardian's Last NameParent or Guardian's Email AddressParent or Guardian's Phone NumberServices Needed Child or Adolescent Psychotherapy Infant Parent PsychotherapyPlease add below the reason you are seeking psychotherapeutic services for your child at this time and why you would like to be considered for funding support with the WCCFF. Personal stories are a great way to educate donors about the public's need of services. Please choose one of the two options below: I agree for my anonymous information to be used for future funding applications or fund raising activities. I DO NOT agree for my information to be used for future funding applications or fund raising activities.Thank you for filling out the form. If you wish to add any other information to support your pre-screening application please do so below. Submit Financial Support Pre-Screening