HEALS - Bursary Request Form

HEALS Course: Bursary Request
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of birth

DayMonthYear
Date
E-mail
example@example.com
Phone number
Which Online HEALS course date you would like to attend (if possible, please choose more than one)?
You can still be added to a waiting list. Please let us know which one you would like to get contacted in case we have a place available?
Under what circumstances are you in need of a bursary?
Course Commitment

The HEALS course runs 8 weeks. The first online session is 2.5 hours. The live sessions in weeks 2-8 are 2 hours.

Outside the live sessions, you will be invited to try some simple practices and meditations in your own time to deepen your learning.

We know this is a big commitment of time and energy. As our bursary spaces are limited, we ask you to consider whether this is something you have the capacity to do right now.
How do you feel about the course commitment requirement?

Other - share your thoughts here
Payment

We ask you to consider how much you are able to fund yourself and we will cover the remainder from our bursary fund.
How much are you able to pay (see notes above)?
Please provide any other information you think is relevant to this application (that can include your health condition for the Health course)
Bursary places are funded by our charity and supported by public donations. We often follow-up with bursary recipients to ask about the impact of the course, and may use these testimonials to support with our fundraising. How would that feel for you?
Funding Monitoring Information
Why do we need this information?

Collecting this information will provide useful anonymous data that may help Breathworks to secure funding in the future. This in turn will help us award bursaries to more people, so more people will be able to benefit from mindfulness training.

The monitoring information has no basis in our decision-making process and this data will never be shared with anybody and will be held securely in accordance with the standards set out in the GDPR and the Data Protection act 2018.
Do you live with a long term physical or mental health condition?

If yes, please provide details of the condition
Do you have a disability?
Are you currently unemployed?
Are you from Black, Asian, Minority Ethnic (BAME) heritage
Do you identify as LGBTQ+?
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Thank you for completing the application. Please click submit and your application will be reviewed by a member of the team.
OpenCRM Subject
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VAT
Start date

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HEALS Course: Bursary Request

Funding Monitoring Information

Privacy & Cookies Policy