The Web Counseling Site Index
WebCounseling Registration Form
Those Without Sufficient Funds To Pay
Directions: Please complete this form, then click on the submit button at the bottom of this page. All information is required. Do NOT leave anything unanswered.
You must list all income from all sources. If you need more space use the comments section. Also, list any assets you hold in the Comments box below. Since we are unable to offer free counseling to all that apply, misinformation could result in depriving someone else who may need these services more than you.
Note all the information that you submit is subject to verification.
For example: firstname.lastname@example.org
2003 The Web Counseling Site
RETURN TO THE INDEX