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:*

State:*

Native Language:*

Zip Code:*

Occupation:*

Home Phone Number:*

Employer:*

Work Phone Number:

Highest Grade Completed:*

E-Mail Address:*

 

 

YOUR SPEECH:

At what age did you begin to stutter?*


What is your estimate of the present severity of your stuttering?*


Is your present level of stuttering your usual severity level?*



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

 
OTHER FAMILY MEMBERS:

Family Member

Paternal/Maternal

Living/Deceased

Severity

YOUR HEALTH:

General Health*

Handedness*

Hearing Problems*

History of Chronic Ear Infections*



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:


 

 

           

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