Clone of COURSE ENERGY LEVEL 1 PAYMENT FORM

Scholarship Application Form

Or Emuna Energy Institute
With all of our hearts we are happy to consider aiding the possibility for you to join our programs through the generous donations of many who believe in the healing opportunities Or Emuna Energy offers. Because of them we are able to offer scholarships up to $500 based on fund availability and applicant qualification.
Date*

MonthDayYear
Date
Participant Name*

First NameLast Name
E-mail*
Phone Number For WhatsApp*

Area CodePhone Number
Phone Number (Home/Cell)

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCounty
Best way to reach you?*

PhoneEmailWhatsappOther
What are the best times to reach you?
Date of Birth

MonthDayYear
Date
Current age
Please briefly share with us your financial situation: **PLEASE CONSIDER THE FOLLOWING: payment plans (up to 3 installments) are available for programs and retreats. For many this may serve to relieve the financial burden of payment without further need of scholarship funding***
What will the scholarship be applied to?

VIRTUAL - Or Emuna Energy Training (Or Nafshi) Level 1LIVE - Or Emuna Energy Training (Or Nafshi) Level 11-on-1 Thereapy by Orit EstherRetreatOther
Please briefly explain why you need this program, retreat, service at this time:*
Reference to vouch for your financial status: Name/Phone number/Email address:*
*Our committee will contact them upon their discretion*
What is the maximum amount you can afford to pay for this program with 3 monthly payments. We will try to accommodate but scholarship funds are limited.*
Who referred you to Or Emuna?*
PLEASE NOTE: You are affirming by signing on this application that you are aware that all scholarships were donated to our fund from people's ma'aser money.

Please grant us up to one week for our team to process your application.
Your Name*
Signature*

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Scholarship Application Form