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*
Please confirm that you identify as BIPOC (Black, Indigenous, Person of Color).*

YesNo
What is your profession?*
Are you NCBTMB Certified?*

YesNo
Have you studied CST before?*

YesNo
When and with whom have you studied CST?
Have you studied other kinds of bodywork?*

YesNo
Which kinds of bodywork have you studied?
Do you attend births?*

YesNo
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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