Scholarship Application

Full Name

Email Address

Phone Number

Which retreat are you applying for?

Why are you interested in this retreat?

Are you open to sharing a room with another participant? Are you open to sharing a room with another participant? Yes No

How did you hear about this retreat?

How would attending this retreat impact your personal well-being?

Have you participated in wellness programs before? If so, what did you gain from them?

What challenges are you currently facing in your personal or professional life?

Are financial resources prohibiting your wellness goals?

What are you hoping to learn or experience during this retreat?

How do you plan to integrate what you learn from this retreat into your daily life?

Are you fully able and committed to attending the entire retreat if selected?

What does “wellness” mean to you, and how do you prioritize it in your life?

Annual Income (Select One) Annual Income (Select One) $20,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000+

Do you have tax documents to support this? Do you have tax documents to support this? Yes No

Confirmation Confirmation I attest that the above information is accurate and truthful

Signed

Date