GTIP Gloria E. Ramos Latinx Scholarship Application

GTIP Gloria E. Ramos Latinx Scholarship Application

Complete the application below as accurately as possible. The information you submit is confidential. A committee of Board members and faculty will review your application and make Tuition Assistance determinations by July 1.
Name*

First NameLast Name
Pronouns
Email*
example@example.com
During its 38-year history, the Gestalt Training Institute of Philadelphia (GTIP) has graduated over 300 trainees with little more than a dozen of those trainees being BIPOC. Between 2019 to 2025, GTIP has made a commitment to challenge this disparity in the following ways:

-offering free tuition to 9 trainees of the African Diaspora between the years of 2019-2025.

-starting the Gloria E. Ramos Latinx Scholarship.

Latinx applicants in the tri-state area who work as behavioral health providers are eligible to apply. Preference is given to pre-licensed professionals.

The goals of the GTIP Gloria E. Ramos Latinx Scholarship are to:

-Increase the number of Latinx Gestalt Therapy Practitioners within the GTIP community through training.

-Expose Latinx communities to the benefits of Gestalt Therapy Theory by training Latinx practitioners.
Indicate your cohort year:

Class of 2024Class of 2025Class of 2026
Are you licensed or pursuing licensure? *
If so, which type of license?
Workplace Name and Address*
Are you eligible for Tuition Reimbursement from your employer? If so, how much per year?*

$3,600-$4,500$2,700-$3,599$1,800-$2,699$900-$1,799$1-$899$0
Tell us about the population you work with:*
How will GTIP training support your clinical development and endeavors?*
Why are you applying for this scholarship (please describe your financial situation with relevant details about why you are in need of the scholarship at this time).*
What is your annual gross income?*

$75,000 and up$60,000-$74,999$45,000-$59,999$30,000-$44,999$15,000-$29,999$0-$14,999
Do you receive financial support from anyone? If so, what is the annual amount you receive?*

More than $4,800$3,600-$4,799$2,400-$3,599$1,200-$2,399$1-$1,199$0
Do you have any dependents that you support?*

5 or more43210
Do you carry any debt other than mortgage, school or car loan?*

$20,000 or more$15,000-$19,999$10,000-$14,999$5,000-$9,999$1-4,999$0
Do you have any student loans? If so, what is the amount you pay per year?*
Do you support loved ones (who are not dependents)? Please average the annual amount you have contributed per year over the last two years.*

$4,000 or more$3,000-$3,999$2,000-$2,999$1,000-$1,999$1-$999$0
What are your annual health insurance costs (or if you don't have health insurance, please skip to the next question)? If you have a high deductible plan, please include that annual deductible amount in your answer.*

$10,000 or more$8,000-$9,999$6,000-$7,999$4,000-$5,999$2,000-$3,999$1-$1,999
Do you have extraordinary medical expenses for yourself or family members/loved ones? If so, how much per year do you contribute?*

$20,000$15,000-$19,999$10,000-$14,999$5,000-$9,999$1-$4,999$0
Do you belong to any marginalized groups in addition to being Latinx (please check all that apply)?*

LGBTQDifferently abled physicallySerious or persistent mental challengesOver 55ImmigrantOtherNone of the above
If you checked "other" above, please elaborate:
Please upload your 2021 and 2022 (when complete) Income tax returns.*

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Please upload your Personal checking account, savings account, and any investment account statements below:*

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Please upload any Business Checking and Business Savings Account statements below:*

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Signature*

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