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Apply for Funding

Submit your application for financial assistance to support your needs.

Basic Information

Full Name*

Date of Birth*

Email*

Phone*

City & State*

Service & Background

Service Background*

Veteran

Active Duty

First Responder

Family Member

Civilian

Branch of Service (if applicable)

Years Served / Discharge Year (if applicable)

Tell Us About Yourself*

Tell us a little bit about who you are, what led you here, and how you became interested in Ibogaine or psychedelic-assisted healing.

Health & Readiness

Are you currently in therapy, recovery, or another healing program?*

Yes

Are you willing and able to travel for treatment?*

Yes

Unsure

Any medical or safety concerns we should be aware of? (Optional)

Consent

I confirm all information is true to the best of my knowledge.*

I consent to be contacted by Forward Intent for next steps.*

I understand that submitting this form does not guarantee funding or placement.*

Signature*

Please sign below using your mouse or touch screen

What Happens Next

Our team will review your application and contact you within 5–7 business days to schedule a short intake call.

Forward Intent is a nonprofit 501(c)(3) organization dedicated to funding life-changing healing journeys for U.S. veterans through psychedelic-assisted therapy and support. EIN: 93-7083950

Contact

Texas, USA
(646)-204-5342
connect@forwardintent.org
@forward.intent

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We send out reports updating our audience and donors on all the happenings within our organization and those we are providing support to.

Apply for Funding