Community Care Fund | Modern Anarchy

Community Care Fund Application

Thank you for your interest in The Community Care Mutual Aid Fund. At The Pleasure Practice, we are deeply committed to making Sex and Relationship support accessible and affordable for everyone in our community. We understand that seeking support services can be a significant decision, and we want to ensure that financial concerns do not stand in the way of your support. Our sliding scale fee structure is designed to accommodate individuals with diverse financial circumstances, and we are dedicated to working with you to find a fee that suits your needs. Individuals who are able to pay the full $350 per session cost contribute to The Community Care Mutual Aid Fund to allow for the opportunity of sliding scale rates.

We believe in building adaptable relationships, and as your circumstances evolve, we are open to adjusting fees accordingly. If you have any questions or concerns about our fees or payment options, please don't hesitate to discuss them with us by using the contact form. Your feedback is valuable, and we are continually working to improve our services and increase access to care for all.

Please honestly provide the following information and answer the questions below to accurately gauge a sliding scale rate.

Personal Information

First name

Last name

Phone

Gender

Pronouns

Age

Date of Birth

Race and Ethnicity

Sexual Orientation

Relationship Orientation

Your Financials

What is your current employment status? Are you employed full-time, part-time, or not employed at the moment? If employed, what is your monthly or annual income before taxes? Combined income if partnered?

Do you have any dependents? How many people rely on your income, including children or other family members?

Do you have any significant financial obligations or debts? This could include rent or mortgage payments, student loans, medical bills, or credit card debt.

Are you receiving any government assistance or subsidies? Include programs like Medicaid, food stamps, or housing assistance.

Do you have any special circumstances or financial hardships that you believe should be considered in determining your rate?

Nicole's full rate is $350 per hour session. Based on your financial situation, what is a rate that feels fair to you and the value of Nicole's services?

Is there anything else that you think should be considered for your application?

I agree that the information provided honestly and accurately reflects my current financial needs and ability to afford coaching services.

Type Signature (First and Last Name):

Date

Thank you for providing your information. The Pleasure Practice team will be in contact regarding next steps.