Carol Gray Center for CST Studies BIPOC Scholarship Application Form

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

First Name Last Name
E-mail: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

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

Yes No
What is your profession? *
Are you NCBTMB Certified? *

Yes No
Have you studied CST before? *

Yes No
When and with whom have you studied CST?
Have you studied other kinds of bodywork? *

Yes No
Which kinds of bodywork have you studied?
Do you attend births? *

Yes No
What is your role at births?
Why do you want to study with Carol Gray? *
How would you like your name and titles to appear on your certificate of completion? *
For which class(es) and/or certification programs would you like this scholarship?
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