THR Financial Assistance Application Form

The Highlands Retreat

585 Dutch Valley Rd NE Atlanta, GA 30324

Financialassistance@thehighlandsretreat.com
Scholarship Application Form

Application Deadline - April 1, 2024

Please read and follow the instructions carefully prior to submitting your application. All correspondence and assistance agreements will be generated from the personal information submitted below. All Applicants will be contacted on or before the 15th of April 2023. Assistance is provided until allotted funds for this year’s retreat are distributed.
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be send to
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Fellowship(s)*

AAACOAAlanonCODACMANAOASCA
Rooming Information (Information regarding gender and disability are needed for room assignments and in no way affects your selection for financial assistance.)
Gender*

FemaleMaleOther
Do you have a disability that will affect your housing placement?*

NoYes
Please describe your disability and your needs*
Have you paid the required program fee?*

NoYes
Assistance is provided to those folks who have paid the program fee on a first come first serve basis until allotted funds for this year’s retreat are distributed. Please pay promptly here
Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. All financial assistance will be applied to the cost of housing and meals at The Mountain. Those receiving financial assistance will be responsible for paying the Program Fee of $45 by April 1, 2024 here.

Availablity of financial assistance will be based on a first come first basis of those who have paid the program fee.
Signature*

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Scholarship Application Form

Application Deadline - April 1, 2024

Applicant's E-Signature