The Theraplay Institute: 2023-24 Training and Practicum Scholarship Form

BIPOC Theraplay Practitioner Scholarship Application

Thank you for your interest in Theraplay training and certification opportunities! Applications are reviewed as received and scholarships are awarded on a rolling basis. The current scholarship award period begins June 1 and continues so long as funds are available. Applicants must identify as a person who is Black, Indigenous, and/or a Person of Color and be located in the US or a US territory (and able to travel for training). A separate application must be submitted for each training and level of practicum. Please email us at info@theraplay.org if you have any questions.
YesNo
Name*

First NameLast Name
Email*
example@example.com
Organization*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I am requesting scholarship support for the following (select one): *
If applying for training support, please list the specific training, location, and dates you are hoping to attend (enter N/A if not applicable or unsure)*
Start date of training program must be 30 days or more from the date of submission of your application. Module scholarships awarded may be applied to one full set of Modules 1-6. View our training calendar at www.theraplay.org
YesNoN/A
How do you currently use your Theraplay training to support your work or how will you use it to support your work?*
Signature*

Clear
Demographic Information

The purpose of these self-identification questions is to collect information so that the organization can monitor the equity performance of our scholarship program and to support future developments that achieve greater equity, diversity and
inclusion for BIPOC clinicians seeking Theraplay training and certification to support their practice.

Answers to these questions will not impact your eligibility for the scholarship for which you're applying, and all identifying information will be removed from any scholarship program analysis or review.
Non-profit/Community AgencyFor-profit/Private PracticeGovernmentEducationOther
0-5 years5-10 yearsMore than 10 years
AfricanAfrican-American/BlackAsian-AmericanEast Asian (including Chinese, Japanese, Korean, Mongolian, Tibetan, and Taiwanese)Hispanic/LatinxIndigenous American/First Nations (including Native American, Alaskan Native, Pacific Islander, and Native Hawaiian)Middle EasternRomaniSouth Asian (including Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, and Sri Lankan)Southeast Asian (including Burmese, Cambodian, Filipino, Hmong, Indonesian, Laotian, Malaysian, Mien, Singaporean, Thai, and Vietnamese)WhiteNot listed, please specify
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BIPOC Theraplay Practitioner Scholarship Application