Carol Gray Center for CST Studies BIPOC Scholarship Application Form

Carol Gray Center for CST Studies BIPOC Scholarship Application Form
Full Name:

First NameLast Name
E-mail:
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
Please confirm that you identify as BIPOC (Black, Indigenous, Person of Color).
What is your profession?
Are you NCBTMB Certified?
Have you studied CST before?
When and with whom have you studied CST?
Have you studied other kinds of bodywork?
Which kinds of bodywork have you studied?
Do you attend births?
What is your role at births?
Describe your existing role in serving people during the perinatal period and infancy.
How do you envision using the skills you learn from Carol Gray to address racial and social justice during the perinatal period and infancy?
Why do you want to study with Carol Gray?
If you are selected how would you like your name and titles to appear on your certificate(s) of completion?
For which class(es) and/or certification programs would you like this scholarship?
Please attach your resume.

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