"Community Access" Reiki Certification Application Form
Thank you for your interest in this special scholarship training in honor of the Martin Luther King Jr. National Day of Service. Please answer the questions below to apply for one of the 6 available seats.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you find out about this class?
*
Google
Facebook
Twitter
LinkedIn
Instagram
Flyer
Student/client referral
Word of mouth
One of the core goals of this MLK Day initiative is to increase BIPOC (Black, Indigenous, and People of Color) representation in the healing arts. Do you identify as a member of the BIPOC community?
*
Yes
No
Prefer not to answer
Why do you feel called to learn Reiki at this time in your life?
*
0/0
This "Community Access" rate is intended to support those with financial barriers. Briefly, how would this scholarship tuition ($120) impact your ability to attend?
*
0/0
Are you able to commit to the full schedule (Jan 16-17, 9:00 am-6:30 pm) in Durham? (Yes/No)
*
Yes
No
Do you understand the $120 tuition is non-refundable upon acceptance? (Yes/No)
*
Yes
No
Signature
*
Submit
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