Scholarship Form Application

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Soul Survivor Ink’s program is an outreach ministry designed to provide safe, effective, and free tattoo removal or cover-up services for survivors of human trafficking.

Qualifying brandings:

Any markings, scars or tattoos that were received while under the influence of a pimp or trafficker.
Area must not be over 5×5 inches in size.

Applicants that do not meet the qualifications have the opportunity to be accepted in our Soul Support Program.

All applicants must have a letter of recommendation from an official advocate. The advocate letter can be attached below.

Photos of requested brandings must be attached below.

Please complete your scholarship application in its entirety. All incomplete applications will be asked to resubmit a new application.

All submitted scholarship forms will be reviewed and our team will contact you shortly providing the available options.

Name of Survivor

First Name

Last Name

City

State

Phone

Date of birth

Please select the origins of your scar or tattoo

Would you like for the tattoo/scar(s) to be covered or removed?

Please note: Removal sessions are limited to five. We cannot guarantee that the tattoo will be completely removed after the allowable sessions. It is recommended for darker and larger marking to request a cover-up.

Available tattoo artist locations

Available tattoo removal specialist locations

Available esthetician locations

How many cover-ups or removals are you requesting?

Size of tattoo/scar(s)? (Size must be clarified in inches)

Description of tattoo/scar(s) you want removed/covered up.

Please provide a brief description of your situation during the time in which you received the tattoo/scar(s).

Approximately, what year was the tattoo/scar(s) received?

Please provide a brief description of your situation during the time in which you received the tattoo/scar(s).

Name of Advocate

An advocate is an approved individual that is required to be present during your appointments. The advocate is there for the support of your journey removing or covering your brandings. Acceptable advocates are as follows:

Program director or a leader/advocate from a safe home or program
A pastor or a Church affiliate
Parole officer
Someone from DCS
A leader or director from a sober living or similar program
A sponsor from AA or any other program you were a part of
NO boyfriend/girlfriend allowed to be advocates

If you are having a difficult time finding an advocate please contact us and we will do our best to guide and help you.

Advocate First Name

Advocate Last Name

Email of Advocate

Phone Number of Advocate

Do we have permission to contact your advocate?
YesNo

Name of Parent or Guardian (if applicable)

First Name

Last Name

Email of Guardian

Phone Number of Guardian

Do we have permission to contact your guardian?
YesNo

Picture of tattoo upload

The advocate letter is a letter that shows you have community-based support to move forward with your life. We accept letters from parole officers, reentry officers, community service coordinators, social workers, therapists, counselors, halfway house representatives, and affiliate organization leaders. We will not accept letters from family or friends.

Advocate letter upload

How did you hear about Soul Survivor Ink's program?

72748

Consent

In filling out this form of consent, I acknowledge that I may be provided procedures for branding removals and cover-ups. I understand that tattoo removal is a process that requires more than one treatment and that I will be provided five sessions. After these five sessions, I will go to a review board for additional sessions if needed. I understand that a fully refundable booking fee of $50 is required. I understand that I will be obligated to attend each of these appointments in a timely manner. I understand that if a cancellation is required and I do not cancel with at least 48 hours notice, my $50 booking deposit will be kept.

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