Treatment Fund Application

*indicates a required field

  • To maximize the benefit of this scholarship, We ask that the health care providers support the recipients by offering services on sliding scale basis. The following are suggested rates:
  • $ Fee per session: $50 per individual and $25 per
    group therapy station
  • #Sessions: 10 individual and 20 group therapy sessions
  • Total Scholarship Available: $500
  • Please indicate how you and your treatment provider intend on allocating the funds:
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.

Applicant must have a diagnosis of an eating disorder, or be seeking an assessment for one. Funds will be provided upon approval, directly to the licensed treatment provider. Please print this form, fill it out, and return by mail with an annual tax document, a W2, or a current pay stub or a formal verification of financial status to:

EDRS Treatment Fund Application
c/o Treasurer, EDRS
911 Lakeville Street, Suite 217
Petaluma, CA 94952