Keen Giving Program Application

Keen Giving Program Application 


HabitAware is committed to ending the stigma around Body Focused Repetitive Behaviors (BFRB) and getting help to those in need. We want to give back to our BFRB community and help eliminate financial barriers for individuals who may benefit from a Keen bracelet.

To apply, please complete the form below. Incomplete applications and multiple submissions will not be considered. Applications are reviewed on a rolling basis, and selections are made rolling as well. Please note that we will only notify chosen recipients due to the volume of applications we receive.

If chosen, the HabitAware team will contact you via email with additional information. If you agree to participate, we'll take your shipping information and color/size preference for your one Keen Sporty bracelet. (A second Keen can be purchased at a subsidized price.) 

Applicants must be 18 years or older. If under 18, please ask a parent or guardian to apply on your behalf. 

Your Name *
Your Name
First Name
Last Name
Phone number *
Recipient of Keen bracelet *
Relationship to applicant
--select-- Self Child Parent Other family Friend Patient Other
Nominee Name
Nominee Name
(If different from "Your Name" above)
First Name
Last Name
For which behavior(s) will the Keen be used? *
Trichotillomania (hair pulling)
Dermatillomania (skin picking)
Nail biting
Thumb sucking
Other
Social media account (Facebook, Instagram, Twitter) *
Choose one social media account to share with us and paste its URL here. If you are a minor, or don't use social media, just write "n/a" below.
Short essay questions
Please respond within the word count range. Pro tip: draft your answers in a separate document and paste here when you are ready to complete the form!
1) Tell us your "BFRB" story *
100-200 words. (BFRB stands for body focused repetitive behavior - things like hair pulling, skin picking, nail biting, nose picking, etc.)
2) HabitAware's mission is to promote knowledge of BFRBs. How will you use your Keen to raise awareness of BFRBs? *
100-200 words
3) Please describe the circumstances in which you are seeking financial assistance for Keen. *
100-200 words Please use this space for any additional information that you would like the HabitAware team to consider.
4) If you are the recipient of a Keen bracelet, how will you use it? How will Keen help you? *
Words are cool, but we'll give preference to video submissions, so share your unlisted Youtube link here. (Vimeo and other video-hosting sites are accepted too.)
Permissions
By checking this box, you confirm that you are over 18 years old.
By checking this box, you give us (HabitAware, Inc.) permission to use your (and/or your minor child’s) image, first name, video, essay, story, and likeness for promotional purposes in our public marketing materials (including but not limited to the HabitAware website and social media profiles) and for distribution to public media outlets. We will never sell your information to third parties
By checking this box, you would like receive our newsletter.
Please review the application before submitting
By submitting the application, I acknowledge that I have completed the application truthfully and to the best of my knowledge.
Sizing Guide

Not sure which size is right for you?

It's important that Keen fits snugly. Here's a quick guide to help you decide which bracelet size to order:

(images not to scale)

Ready for "Keen" Awareness?

Our 3-min email shares 1 actionable tip weekly to help you manage your hair pulling, nail biting or skin picking & CHANGE FOR THE BETTER.