Scholarship ApplicationIf you would like to be considered for a healing scholarship, please complete the application below. All applications will go through a confidential review process by our board. Name * First Name Last Name Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business/Organization Name Are you a veteran, family member of a veteran, or civilian? * Veteran Family Member of Veteran Civilian What kind of support are you seeking right now? * Are you open to holistic or non-traditional therapy options? * Yes No Maybe Have you worked with a therapist, healer, or coach before? * Yes No Why do you feel this scholarship could help you right now? * Any specific needs, accommodations, or spiritual/cultural preferences we should honor? * I understand this is not emergency or crisis care, and agree to be contacted regarding this application. * Yes Thank you!
