Milford Church of God

Counseling - Discount Scholarship Application Form

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Through the generosity of Eagle’s Wings Counseling, legacy giving from past clients and other donations we are able to offer discounts greater than 30% to those with an annual income of less than $30,000 / year.

Personal Information

All information you provide will help to determine if you qualify for a discount greater than 30%. All information you provide will be kept strictly confidential.

First Name Last Name

First Name Last Name
Phone Number
Email Address

***Please bring a copy of your last two pay stubs for income verification purposes.
* required