Retreat Partial Tuition Scholarship Application Form

Retreat Partial Tuition Scholarship Application Form

For RestWise RiseWise intensive retreat experience
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Academic Information
Name of the program your wish to attend and are requesting assistance for?
Education Level Completed (high school, college)*
Graduation date or expected date to Graduate*

MonthDayYear
Date
Previous Holistic education or certifications
Name & Location of School(s). Date completed.*
Schools or Certifications continued.*
Describe your previous experience with MindBody or holistic education & training.*
Experience continued.

Do you understand the moral & ethical precepts to be embodied during this retreat? Please state them here.*
I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISREPRESENTATION I HAVE MADE CAN CAUSE INVALIDATION OF MY APPLICATION.
Applicant's Signature*
Name of Applicant*

First NameLast Name
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty: