Donation Scholarship Application
Participant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Ceremony Date Applying For
*
-
Month
-
Day
Year
Date
Scholarship Request
Are you requesting a reduced minimum donation amount or a split donation plan for the full donation amount?
*
Requesting one time reduced donation amount. (Full donation amount with $50 reduction)
Requesting split donation plan (full minimum donation amount split over 2 donations)
Other
If Other, please briefly explain below.
We kindly ask that you please be as detailed and as honest as possible for the below sections. 🙏
Why are you seeking a reduced donation or split donation plan for this ceremony?
*
What draws you to this ceremony at this time in your life?
*
How do you feel this experience may support your healing, growth, or integration?
*
Additional Notes or Thoughts About Your Donation
Reciprocity & Community Care
In what ways do you currently give back to your community, or how might you be open to giving back in the future?
*
Is there anything else you would like us to know when considering your application?
Agreement
Agreement Signature (typed)
*
Date of Signature
*
-
Month
-
Day
Year
Date
Thank you for your application. We will review it carefully and get back to you soon.
Submit Application
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