Counselling Service Application

Welcome to the Thelma Matilda Alves Foundation Counselling Application

This form is your route into our counselling support programmes for 2026. Depending on your circumstances and location, you may be matched with free counselling sessions, a no-cost therapy voucher, or a place on our supervised trainee counselling programme. Not every applicant will be eligible for support, and which option (if any) you're matched to will depend on your answers below.

Who this is for: Black women, including Black African, Black Caribbean, Black mixed-heritage, and Black trans women, aged 18 or over and living in the UK, who are facing barriers to accessing mental health support.

Important — please read before completing this form

This form is not monitored 24 hours a day and is not an emergency service. If you are in immediate danger or feel unable to keep yourself safe right now, please call 999, contact NHS 111 (option 2), or call the Samaritans free on 116 123 at any time, day or night.

This form asks some sensitive questions about your mental health, safety, and personal circumstances, so that we can match you with the right support and keep you safe while you're on the programme. All information is handled confidentially and in line with GDPR — full details are in the consent section at the end of the form. It takes around 10 minutes to complete.

Submitting this application does not guarantee that counselling will be offered. Once we have reviewed your application, a member of the TMAF team will contact you to discuss the outcome and any next steps.

Thank you for taking the time to complete this application. We appreciate that reaching out for support can be a significant step, and we look forward to reviewing your application.

Your details

This scheme is only open to residents of Birmingham or London.

Eligibility

A few quick questions to check the scheme is the right fit.

Yes
No
Are you a Black woman or Black trans women, including Black African, Black Caribbean, or Black mixed-heritage? *
Are you aged 18 or over? *
Are you a full-time resident of the UK? *
Living in London or Birmingham? *

Your circumstances

Yes
No
Do you struggle to pay your bills? *
Do you struggle to afford food? *
Do you struggle to afford transport? *
Do you struggle to afford counselling? *

Mental Health History & Support

Please tick the boxes that apply to you?

Yes
No
Have you ever spoken to your GP about your mental health? *
Are you currently receiving counselling? *
Have you ever received counselling? *
Are you currently on a waiting list for counselling or receiving support elsewhere? *

Warwick Edinburgh Mental Well-being survey

The survey is a list of statements about feelings and thoughts. Please select the answer that best describes your experience over the last 2 weeks.

None of the time
Rarely
Some of the time
Often
All of the time
I've been feeling optimistic about the future *
I've been feeling useful *
I've been feeling relaxed *
I've been feeling interested in other people *
I've had energy to spare *
I've been dealing with problems well *
I've been thinking clearly *
I've been feeling good about myself *
I've been feeling close to other people *
I've been feeling confident *
I've been able to make up my own mind about things *
I've been feeling loved *
I've been interested in new things *
I've been feeling cheerful *

Safeguarding

This helps us make sure you get the right level of support.

Commitment and availability

Yes
No
Are you able to commit to 15 counselling sessions over 15 weeks? *
Are you available to attend one session per week at a regular time? *
If sessions are online, do you have access to a private space and a reliable phone or internet connection? *

Consent and declarations

Please read each line carefully before continuing.

Yes
No
I understand the Foundation may contact my GP or emergency services if there are serious concerns about my safety *
I understand that following assessment I may be offered a different pathway to the one I selected *
I understand by submitting the form I consent to the information I have provided being used for monitoring, evaluation, and reporting purposes in an anonymised format. I understand that my identity will not be shared in any public reporting, and that any quotes or data used will not be personally identifiable without my further written permission. *
I understand that my contact details will only be used for this purpose if I choose to opt in. I can withdraw my consent at any time by emailing counsellingsch@thelmamatildaalvesfoundation.com or by using the unsubscribe link included in our emails. *
I understand and agree that Thelma Matilda Alves Foundation may contact me after my counselling has ended to invite me to complete follow-up surveys, take part in interviews, or share feedback about my experience as part of the project’s monitoring, evaluation, and impact reporting. *
I confirm the information I have provided is true, complete and accurate *
I understand TMAF counselling is only available to UK residents *
I agree to notify TMAF if my personal details or place of residence change *
I understand that false or inaccurate information may result in suspension or termination *
I would like to receive updates from Thelma Matilda Alves Foundation about counselling services, programmes, events, funding opportunities, and other services that may be of interest to me. *