Sponsorship Application form (Journey to the Wholeness Term 4)

Journey to the Wholeness Term 4 - Sponsorship Application Form

The form is only applicable to Ontario residents and created to understand the needs of each sponsorship's applicants. Grace Health Centre will review each application carefully regarding their qualification to be sponsored. There is no guaranteed that every application will be successfully accepted. Grace Health Centre will make every effort to accommodate people experiencing low resource, take into consideration your financial situation and not turn away anyone unless the seats are full.
Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com
Participants who successfully applied for sponsorship from Grace Health Centre will be asked to help with demonstrations of the exercises by Dr. Wong and to grant permission to use these demonstrations to benefit other participants.

Demonstrations will be part of the course materials for use by Grace Health Centre, other organizations and groups.

Applicants who agree to grant permission will be considered first.

All of the provided information will be protected.
Do you consent to the live demonstration with Dr. Wong and grant permission to Grace Health Centre, other organizations and groups?*

YesNo
What is your employment status?*

StudentFull-time employmentPart-time employmentFreelancerContractorSelf employedRetiredLooking for workOther
What is your marital status?*

SingleMarriedDivorcedSeparatedWidowedRemarriedOther
Do you have any dependents?*

YesNo
How many dependents do you have?*

123456 or more
Do any of your dependents living with disability?*

YesNo
Indicate your household annual income. (annual gross income reported in your tax form in 2023)*

CAD$0 - CAD$26,999CAD$27,000 - CAD$37,999CAD$38,000 - CAD$48,999CAD$49,000 - CAD$59,999CAD$60,000 - CAD$70,999CAD$71,000 - CAD$74,999Other
Indicate your personal annual income. (annual gross income reported in your tax form in 2023)*

CAD$0 - CAD$20,999CAD$21,000 - CAD$30,999CAD$31,000 - CAD$32,999CAD$33,000 - CAD$34,999CAD$35,000 - CAD$36,999Other
Do you live with physical or mental disability?*

YesNo
Are you receiving financial support from the Ontario government and/or federal government?*

YesNo
Indicate the government subsidy(ies) you are receiving now.*

OASGISOntario WorksODSPCPPOther
Are you a new immigrant in Canada? (moved to Canada within 12 months)*

YesNo
Please describe your financial status and why you are applying for sponsorship.*
This course is newly developed by international experts in Emotionally Focused Therapy and facilitated by mental health professionals which incurs a significant cost. What amount you are able to contribute towards the cost of the course?*

CAD$30/session, $300/10 1.5-hour sessionsCAD$40/session, $400/10 1.5-hour sessionsOther
Please provide any additional information that you feel would be helpful for us to consider when reviewing your application.
File Upload. Please upload any type of statement to verify your financial burden. (For example, public pension proof / personal annual or monthly income proof / open-work permit / study permit or others)

Cancelof
Please verify that you are human*
Should be Empty:

Journey to the Wholeness Term 4 - Sponsorship Application Form