MHF DOCUMENTS

For Psychotherapists

Welcome to the Mental Health Fund for Queer and Trans People of Color (MHF for QTPoC). The MHF for QTPoC is a program of the National Queer and Trans Therapists of Color Network (NQTTCN). The MHF was created to provide financial support to increase access to psychotherapy for QTPoC by QTPoC. 

All funds are paid directly to the psychotherapist as a third party payor. Prior to distribution, a third-party payor form needs to be completed by recipient, psychotherapist, and NQTTCN via DocuSign. In addition to the Third Party Payor form, psychotherapists also need to provide a W-9 and invoice to receive payments. All these documents must be provided before payment can be made. 


All psychotherapists participating in the mental health fund need to be either licensed in their field as a mental health provider and/or are a registered intern/associate in their respective field.

This page includes important information for practitioners participating in this program. Please review:

Introductory Letter for Therapists

Outlines the program, expectations and commitments.

Invoice Template

Therapists can use this template or their own invoice as long as it includes all the necessary information required.

Payment Portal

All invoices, W-9 and EFT forms must be uploaded here. DO NOT EMAIL these documents.

EFT Form

Must be completed if requesting payment directly to a bank account.

Sample Third Party Payor Form

To view only. Applicants and therapists will receive their forms via DocuSign.

 

INTRO LETTER FOR THERAPISTS

INVOICE TEMPLATE

SUBMIT INVOICE

EFT FORM

SAMPLE THIRD PARTY PAYOR FORM

P.O. Box 50058

Baltimore, MD 21211

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