In order to qualify for assistance, Kilgore will need the following information so that our Samaritan Fund Committee can determine the need of assistance:
- Completed Samaritan Fund Scholarship Fee and Fee Agreement
- Authorization for Credit Card Charges Agreement
- Two-years’ tax returns
- Two months of consecutive checking account statements
- Two most recent pay stubs (or any other of income such as savings, alimony, investments, SSI/Disability, child support, retirement, spouse income and self).
The Committee will review the submitted information and determine the scholarship and co-pay. In addition to this information, your therapist will be consulted for additional information and our intent is to notify you of the award within 48 hours of the submitted application.
Once approved, those who qualify must pay at least 50% of the standard appointment fee of $150 for the first session and a minimum of $20 co-pay for subsequent sessions. Scholarships are valid for three months. If you cannot afford this initial amount, we can make payment arrangements such as authorizing Kilgore to charge your credit card. If more sessions are needed, a recipient may reapply.
A scholarship may be withdrawn if an appointment is cancelled without notice or co-payments are missed. A $50 charge also will be assessed.