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Request services

Therapy Services Subsidy Request for Newcomer & Immigrant Families in the GTA

Thank you for your interest in CircleUp Foundation's subsidized therapy services. The information you provide in this application will be used solely to determine your eligibility for our sliding scale fee program and to match you with an appropriate therapist. All personal and financial information is kept strictly confidential in accordance with the Personal Health Information Protection Act (PHIPA) and will not be shared with third parties without your consent. Your information is stored securely and accessed only by authorized CircleUp staff involved in processing your application.

 

Eligibility Criteria​

Eligibility for subsidized services is determined by your household size and annual income:
 

  • Under $22K (1 person) to $46K (5 people) - $7.50/session

  • $22K–$29K (1 person) to $46K–$61K (5 people) - $25.50/session

  • $29K–$43K (1 person) to $61K–$92K (5 people) - $60/session

  • Above these thresholds, up to $100K - $150/session
    ​

Additional factors the impact triage order are Newcomer Status and residence in the Greater Toronto Area (GTA).​

We will review your application and respond as quickly as possible, typically within 24- 48 hours. Please note that CircleUp Foundation is not a crisis service. If you or someone you know is in immediate danger or experiencing a mental health emergency, please call 911 or contact the 988 Suicide Crisis Helpline. Additional emergency support resources can be found here. 

Before you begin: This form takes approximately 10–15 minutes to complete. Please have the following ready:

  • Your most recent Notice of Assessment (NOA) from CRA

  • If you do not have an NOA, alternative documentation such as pay stubs, government benefits, letters of employment/settlement workers will be required.

Did you or your family arrive in Canada within the last 3 years?
Yes
No
If yes, when did you arrive?
Year
Month
Day
Do you currently live in the Greater Toronto Area?
Yes
No
Other

Mental health concerns

Who are you seeking therapy for?
Child (under 12)
Teen (12–17)
Adult (myself or another adult in the household)
What are the main concerns you are hoping to address? (Select all that apply)
To what degree are these concerns interfering with daily functioning (e.g., work, school, relationships, self-care)?
Not at all - No noticeable impact on daily life tasks
Mildly - Some difficulty, but generally managing day-to-day
Moderately - Noticeable interference; struggling in one or more areas
Severely - Significant difficulty functioning; daily tasks feel overwhelming
How long have these concerns been present?
Less than 1 month
1-2 months
2-5 months
6-12 months
More than 1 year

Income information

How many people live in your household? (Include yourself, your spouse/partner, and any dependent children or family members who share living expenses)
1
2
3
5
6
Other
What is your current employment status?
What is your total annual household income before taxes? (Include income from all adults in your household: employment, self-employment, government benefits, EI, child tax benefits, social assistance, pensions, etc.)
Under $22,000
$22,000 – $28,000
$28,001 – $36,000
$36,001 – $44,000
$44,001 – $54,000
$54,001 – $67,000
$67,001 – $81,000
$81,001 – $100,000
Over $100,000
Do you have extended health insurance that covers mental health services?
Yes
No

By submitting this application, I confirm that the information I have provided is true and accurate. I understand that I may be asked for additional documentation and that providing false information may result in loss of subsidized services. I consent to CircleUp Foundation contacting me about my application.

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get in touch

647-613-7717

9600 Bathurst Street. Maple, ON, L6A 3Z8

circleuporg@gmail.com

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