1. Application for Services for an Adult
2. Application for Services for a Minor

• Print out the appropriate application form above. 
  

  ("Adult" for persons 18 and up.  "Minor" for persons under the age of 18.)

• Complete ALL paperwork!
  

  (Exception: If you do NOT have insurance, skip the insurance page.)

• Return the completed paperwork, proof of income and deposit to The Family Tree in one of the following ways:

  1.  FAX -	"ATTN:  Dee" to (337) 981-2391
  2.  MAIL -	Dee Atkinson 4540 Ambassador Caffery Building D, Suite B220 Lafayette, LA  70508
  3.  DROP OFF IN PERSON	Monday through Thursday -- 8am to 8pm Friday --  8am to 4pm      The Family Tree      4540 Ambassador Caffery      Building D, Suite B220      Lafayette, LA 70508

  • Make checks out to "The Family Tree"
    
  • Visa or Master Card payments can be accepted by phone or in person
  • Cash Payments accepted IN PERSON ONLY!

   

• Proof of income can be one or more of the following:
  1. A recent check stub
  2. AFDC (food stamps)
  3. SSI
  4. Child Support
  5. Student Loans
  6. Unemployment
     • You MUST submit proof of income in AT LEAST one of the above forms, and if you receive more than one, you are required to submit proof of each that your household is currently receiving.

• If you have Health Insurance, please include a copy of the front AND back of your insurance card for benefit verification purposes.

• Please submit with your application a $20.00 deposit.  This deposit will go towards payment for your first session.  Depending on your income level, your individual sliding fee scale counseling session cost MAY or MAY NOT be more than this.

• When we receive your paperwork, proof of income, and deposit a Family Tree Coordinator will call you to schedule your first appointment.
  • Your individual sliding fee scale counseling session cost will be determined at this time.

IMPORTANT!!! → PRIOR to receiving services, the above information MUST be completed and returned to The Family Tree

1.      Class Registration Form

2.      Demographic Survey Sheet

• Return the class registration form and demographic survey sheet along with payment of the class fee (where applicable) to The Family Tree in one of the following ways:

• Make checks out to "The Family Tree"
  
• Visa or Master Card payments can be accepted by phone or in person