National Queer and Trans Therapists of Color Network

MHF Documents

For Psychotherapists

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

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 the following documents below.

MHF Document

Intro Letter for therapists

Outlines the program, expectations and commitments.

Intro Letter for therapists

Download

MHF Document

Invoice Template

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

Invoice Template

Download

Invoicing portal

Submit Invoice

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

Submit invoice

Submit Google Form

MHF Document

EFT Form

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

EFT Form

Download

MHF Document

SAMPLE THIRD PARTY PAYOR FORM

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

SAMPLE THIRD PARTY PAYOR FORM

Download

W-9 Form

W-9 FORM

W-9 Form - Must be submitted with first invoice only

W-9 Form

Download
EN