"Community Access" Reiki Certification Application Form

"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 NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How did you find out about this class?*

GoogleFacebookTwitterLinkedInInstagramFlyerStudent/client referralWord 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?*

YesNoPrefer 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 ($100) impact your ability to attend?*

0/0
Are you able to commit to the full schedule (Jan 17-18, 9:00 am-6:30 pm) in Durham? (Yes/No)*

YesNo
Do you understand the $100 tuition is non-refundable upon acceptance? (Yes/No)*

YesNo
Signature*

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