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C.A.R.E. Program Application
First name
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Last name
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Birthday
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Month
Day
Year
Multi-line address
Country/Region
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Address
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City
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Zip / Postal code
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Email
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Phone
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Occupation
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Employer, Organization, or Volunteer Organization
Which C.A.R.E. program are you applying for?
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Community Recognition Program-- For qualifying community-serving professionals, emergency personnel, military members, veterans, and others whose work or service may involve significant physical, emotional, emergency, or trauma-related demands.
Financial Support Program-- For individuals experiencing circumstances that make regular massage therapy financially difficult to access.
Both-- I would like to be considered for both Community Recognition and Financial Assistance.
Work & Community Role-- Please briefly describe your occupation, volunteer service, or community role and the responsibilities involved.
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Does your role regularly involve any of the following? Select all that apply.
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Emergency or crisis situations
Exposure to trauma or suffering
Significant physical demands
Caring for vulnerable individuals
Caring for vulnerable or injured animals
High emotional demands
None of the above
Other
C.A.R.E. also provides additional assistance when financial circumstances make regular massage therapy difficult to access. This information helps determine Financial Assistance eligibility. Are financial circumstances making regular massage inaccessible?
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Yes — I would like to be considered for Financial Assistance.
No — I am not requesting Financial Assistance at this time.
I prefer not to request financial consideration.
If you are requesting Financial Assistance, which circumstances currently apply? Select all that apply.
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Loss of employment
Reduction in income or work hours
Medical or healthcare expenses
Significant debt obligations
Supporting children or other dependents
Single-income household
Caregiving responsibilities
Unexpected or temporary financial hardship
Other
If you are requesting Financial Assistance, please briefly describe the circumstances you would like us to consider.
What would access to the C.A.R.E. program mean for you at this time?
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Is there anything else you would like us to know? (Optional)
By signing, I certify that the information provided is accurate. I understand that applying does not guarantee C.A.R.E. approval or a specific rate, and that eligibility may be granted for a limited time and reviewed periodically.
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