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 in size.

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

All applicants must have a letter of recommendation from an official advocate.  The advocate letter can be attached to the scholarship form.

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

    Name of Survivor











    Name of Advocate


    Name of Parent or Guardian (if applicable)



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

    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.

    Consent

    In filling out this form of consent, I acknowledge that I may be provided procedures for tattoo removal, cover-up or scar cover-up at a free or highly reduced rate. 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.