Soul Reset Retreat Scholarship Application
Please complete this application to help us understand your background, readiness, and fit for the retreat.
Applicant Information
Applicant Name
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First Name
Middle Name
Last Name
Application Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Birthdate
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City and State
*
Travel and Housing Comfort
Do you have a passport?
*
Yes
No
Passport status
Please Select
Active
Expired
Other
Are you comfortable traveling outside the United States?
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Yes
No
Are you comfortable traveling to Mexico?
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Yes
No
Are you comfortable with staying in a shared beach house with other retreaters in Tulum Mexico? The home has AC, running water and electricity. It is fully functioning and beautiful.
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Yes
No
Retreat Interest and Current Circumstances
What has you interested in this retreat?
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What current challenges are you navigating in your life that you could use support in?
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Are you undergoing any milestones or transitions?
What is the state of your mental, emotional, and physical health?
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Do you feel connected spiritually? If so, why? If not, why?
Do you have spiritual practices in place? What are they?
Do you have emotional support?
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Do you have a like-hearted and minded community available to you? Are you engaged and how do you participate?
Health and History Screening
Do you experience depression and/or anxiety?
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Yes
No
Prefer not to say
If yes, please describe any mental health conditions or injuries.
Are you currently taking any medications for mood or mental health support?
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Yes
No
Prefer not to say
If yes, please list the medications and what they are for.
Have you ever been hospitalized for a mental health condition or attended a recovery program?
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Yes
No
Prefer not to say
Do you have any heart health conditions such as high blood pressure or heart disease?
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Yes
No
Prefer not to say
Have you ever struggled with substance use involving alcohol or drugs?
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Yes
No
Prefer not to say
Have you ever attended a recovery program for alcohol or drug use?
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Yes
No
Prefer not to say
Does your family have a history of substance use challenges or mental health conditions?
*
Yes
No
Prefer not to say
Please list any major life traumas, if any, and share anything else you feel we should know.
Relationships and Fit
Are you married or have a partner?
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Yes
No
Prefer not to say
Do you have children?
*
Yes
No
Prefer not to say
Do you have a supportive family? Share a little bit about your relationship with your mother and father.
What are your deep needs, intentions, and desires for going on this retreat?
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Why is this the right time and right fit for you?
*
Submit
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