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Application for Scholarship

As a registered 501(c)(3) organization, we actively seek grants and donations to help offset treatment costs. Depending on available funding, Living Water Clinics may be able to cover a significant portion of treatment expenses.

If you have been invited to apply, please complete the form below.

Some grants are specifically designated to support residents of Horry County. As a result, eligibility for certain funding opportunities may be limited to individuals who live within the county.

I am a resident of Horry County.
Yes
No
Birthday
Month
Day
Year

We ask all scholarship recipients to demonstrate their commitment to completing a full treatment schedule—given our center's limited capacity—by pledging to contribute "whatever I can" toward the cost of treatment. No amount is too little or too much, and this contribution is not intended to create a financial burden but rather to reflect your dedication to completing your prescribed course of treatment.


Every dollar contributed goes directly to the general scholarship fund, helping to sustain future financial hardship scholarships and offset treatment costs.

Are you able to provide a copy of your most recent IRS Form 1040 for income verification?
Yes
No

Attestation.


I certify that the information provided in this attestation is true and accurate to the best of my knowledge. I understand that any misrepresentation may result in the denial of financial assistance or other corrective actions as deemed necessary.

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