KnowHQ BIPOC Scholarship Application Form
This is the application form for the KnowHQ Fertility Awareness self-paced course. This program is exclusively for BIPOC from Australia. If you are not Black, Indigenous or a women/menstruator of colour and an Australian citizen, permanent resident or visa holder your application will be immediately declined.
Name
*
First Name
Last Name
What are your pronouns?
*
She/her
They/Them
He/Him
Rather not say
Email
*
example@example.com
What race/ethnicity(ies) do you most closely identify with?
*
Indigenous - (Aboriginal or Torres Strait Islander)
Pacific Islander - (Polynesian, Maori, Papuan)
Asian - East Asia (China, Japan, Korea, Taiwan, Hong Kong)
Asian - South East Asia (Cambodia, Thailand, Philippines)
Asian - South Asia (India, Pakistan, Bangladesh)
Black - North African
Black - Sub-Saharan Africa (East African, Southern African, Central African, Western African)
Hispanic or Latino
Mixed ethnicities/race
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you an Australian Citizen, Permanent Resident or Visa Holder?
*
Citizen
Resident
Visa Holder
Do you have any prior experience with Fertility Awareness?
*
Could you please tell me, in your own words, why you are interested in learning Fertility Awareness?
*
I confirm that my information is correct
*
Submit
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