Get Help

Apply for Help

You can apply for yourself, or for a young person you're worried about. Everything you share stays confidential. We're currently only able to support young people living in South Africa.

Need help right now? If you or someone else is in immediate danger, call 112. For urgent mental health support, Suicide Crisis Helpline (SADAG) is open 24 hours, every day on 0800 567 567.

More help

Before you apply, it's worth reading how the process works and our disclaimers.

About the applicant

Tell us who this application is for. If you are applying on someone else’s behalf, enter their details here.

Applicant's first name *

Applicant's last name *

Date of birth *

We support young people aged 13 to 25.

Email address *

Phone number *

Country of residence

Home address *

Who is filling in this form?

Your name *

Your relationship to the applicant *

What support you need

A short note in your own words, plus one quick question about whether this is the first time you’ve looked for this kind of help.

What kind of support are you looking for? *

Have you received this kind of support before? *

YesNoPrefer not to say

Emergency contact

Someone we can reach if we ever have a serious concern about the applicant’s safety.

Full name

Relationship to applicant

Phone number

Email address

Mental health

Share as much or as little as feels comfortable. Everything here is confidential.

Please describe the current mental health struggles *

Has there been a diagnosis of any mental health conditions?

YesNo

If yes, please provide the diagnosis

Any medication currently being taken for mental health?

YesNo

If yes, please list the medications

Currently receiving therapy?

YesNo

Current therapist (if there is one)

Therapist's name

Therapist's phone number

Therapist's email address

How do you believe receiving therapy will impact their mental health and overall well-being?

Financial situation

This helps us understand need. We do not share these details outside our review team.

Currently employed?

YesNo

If yes, please provide details about the job (title, employer, income)

Any dependents?

YesNo

If yes, how many dependents?

Please list any current financial obligations (e.g. rent, utilities, debts)

Have you applied for financial aid from any other sources?

YesNo

If yes, please provide details about other financial aid applications

Is there medical aid cover?

YesNo

Medical aid provider

Plan / option name

Please explain why financial aid for therapy is needed *

Your circumstances

The Foundation has limited funds, and we prioritise the young people with the greatest financial need. The questions in this section help us decide who we are able to support, so please answer them as accurately as you can. If you are not sure of an answer, choose "I don’t know" rather than guessing.

Province *

City or town *

Suburb, township or area *

Area type *

Number of people living in your household *

Approximate monthly household income *

Does anyone in your household receive a SASSA grant? *

Child Support GrantChild Support Grant Top-UpCare Dependency GrantFoster Child GrantDisability GrantOlder Persons GrantGrant-in-AidWar Veteran's GrantSocial Relief of DistressNoneI don't know

Select all that apply, including “None” or “I don’t know” if neither applies.

Name of school, college or university

Leave blank if not currently studying.

School quintile, if you know it

Primary caregiver's employment status *

Who referred you, if anyone? *

Their name, if you know it

How did you hear about us? *

Helping us report to our funders

The companies and organisations that fund our work require us to report on who we help, as numbers and percentages rather than names. The questions in this section are for that reporting only.

None of these answers are used to assess your application, and they will not affect the support you receive.

Answering them helps us raise the funding that lets us help more young people, so please do if you are willing. For the questions about population group and disability, “Prefer not to say” is a perfectly acceptable answer and choosing it changes nothing about your application.

I agree that the Foundation may record my population group and whether I live with a disability, for reporting to funders including B-BBEE socio-economic development reporting. I understand that giving this information is my choice, that I may answer “Prefer not to say”, and that it is not used to assess my application.

This stays optional even though the questions below are answer required. Declining this and still answering “Prefer not to say” below is completely fine.

Population group *

South African citizenship *

Gender *

Do you live with a disability? *

YesNoPrefer not to say

Verification and consent

Last step. These confirmations let us verify the application and arrange care.

Upload a copy of the applicant's ID or identification document *

Accepted: JPG, PNG or PDF. Photos are shrunk automatically; a PDF can be up to 4MB. Documents are handled confidentially and are sent only to our secure case-management board.

I certify that the information provided in this application is true and accurate to the best of my knowledge, and I understand that providing false information may result in the denial of this application for financial aid. *I agree that the Aimee Howard Foundation may collect and use the personal information I have given here to assess my application, arrange and pay for support services, keep records of the assistance provided to me, and contact my therapist or other healthcare providers to verify information related to this application. *

The Foundation may share my story without my name or any identifying details in fundraising material, reports to funders and on our website.

I understand that I can withdraw this permission at any time by emailing the Foundation, and that declining will not affect my application or the support I receive.

The Foundation may contact me after my support has ended to ask how I am doing and how the support helped. I understand this is so the Foundation can measure whether its work is effective, and that I can decline or stop these messages at any time.

This application includes health information. Our privacy policy explains what we collect, who can see it, and how long we keep it. See how the process works and our disclaimers, including how many sessions we typically fund.

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