HCRI Scholarship Program
 

The HCRI scholarship program is designed to make effective stuttering therapy available to more people who suffer from the debilitating effects of stuttering.  Scholarships will be awarded based on financial need and designated to offset the cost of tuition to attend the Institute’s 12-day therapy program.   Funding for scholarships is made possible through the generosity of past clients who want to give the gift of fluency to others because HCRI’s therapy has made such a remarkable difference in their lives. Scholarship awards will be selective and range from $500 to full tuition.  Recipients will be determined based on household income, number of dependents, and other financial circumstances. How to Request a Scholarship 1) To apply for a scholarship, you must first complete a program application (below) to attend one of HCRI’s 17 annual stuttering therapy sessions.   2) Once you submit your program application, we will contact you about your participation and forward a scholarship application for you to complete. 3) Complete and return the scholarship application to HCRI.  We will review your information and advise you of your qualification for an award.  If you have questions about HCRI’s scholarship program, or for information on available session dates, therapy fees and insurance requirements, call Linda Booth at 540-265-5650 any time Monday – Friday from 9 a.m. to 4 p.m. (EST). The HCRI Application Process Please Note: HCRI therapy is only offered on-site at our facilities in Roanoke, Virginia USA for ages 11 and up. If you are not able to attend treatment at HCRI, or are under the age of 11 years, please CLICK HERE for information about how you can obtain information about other stuttering treatments. This is an application for participation in HCRI's therapy program. Please do not fill this out unless you wish to attend HCRI: GENERAL INFORMATION: First Name* Middle Name* Last Name* Mailing Address:* Date of Birth:* City:* Sex:* not selected Male Female State:* Native Language:* not selected English French German Hebrew Italian Spanish Other Zip Code:* Occupation:* Home Phone Number:* Employer:* Work Phone Number: Highest Grade Completed:* not selected Grade School High School Some College College Graduate Post Graduate E-Mail Address:*     YOUR SPEECH: At what age did you begin to stutter?* not selected Before 3 years old Between 3 and 5 years old Between 6 and 9 years old Between 11 and 14 years old After age 15 What is your estimate of the present severity of your stuttering?* not selected Mild Moderate Severe Is your present level of stuttering your usual severity level?* not selected yes no Cannot tell Please check all of the various types of stuttering therapy that you have received: Acceptance Hypnosis Air Flow Metronome Articulation Psychiatric Treatment Counseling or Psychology Relaxation Delayed Auditory Feedback Slowed Speech Desensitization     FAMILY HISTORY OF STUTTERING: Please list all family members, living or deceased, who stuttered. State their relationship to you (brother, uncle, sister, etc.), which side of the family they represent (maternal or paternal) and their stuttering severity (mild, moderate or severe). NOTE: This section must be completed. Family Member Living/Deceased Severity None Father Mother Brother Sister not selected Living Deceased not selected Mild Moderate Severe None Father Mother Brother Sister not selected Living Deceased not selected Mild Moderate Severe None Father Mother Brother Sister not selected Living Deceased not selected Mild Moderate Severe None Father Mother Brother Sister not selected Living Deceased not selected Mild Moderate Severe None Father Mother Brother Sister not selected Living Deceased not selected Mild Moderate Severe   OTHER FAMILY MEMBERS: Family Member Paternal/Maternal Living/Deceased Severity None Grandfather Grandmother Uncle Aunt not selected Paternal Maternal not selected Living Deceased not selected Mild Moderate Severe None Grandfather Grandmother Uncle Aunt not selected Paternal Maternal not selected Living Deceased not selected Mild Moderate Severe None Grandfather Grandmother Uncle Aunt not selected Paternal Maternal not selected Living Deceased not selected Mild Moderate Severe None Grandfather Grandmother Uncle Aunt not selected Paternal Maternal not selected Living Deceased not selected Mild Moderate Severe None Grandfather Grandmother Uncle Aunt not selected Paternal Maternal not selected Living Deceased not selected Mild Moderate Severe YOUR HEALTH: General Health* not selected Excellent Good Fair Poor Handedness* not selected Right Left Ambidextrous Hearing Problems* not selected No Yes At an earlier age History of Chronic Ear Infections* not selected No Yes SPECIAL NEEDS: So that we may better accommodate any special needs that you might have, please indicate any of these conditions that are applicable to you. (please check all that apply):     If checked, please explain: Additional Speech Problem Additional Behavioral Problem Cerebral Palsy Dyslexia Learning Disability Mental Retardation Required to take medicine Please describe in the box below any other special condition that influences your daily functioning. If there are any other questions, comments or information that you wish to call to our attention please enter that information below: