Scholarship Application

Scholarship Application

New Life Rising
Thank you for your interest in our scholarship program.

If you have the financial means to attend the retreat, we kindly ask that you do not apply. This program is not intended as a means to receive a discount. It exists to support those who truly would not be able to access this experience otherwise. Applying when you do not meet the criteria takes away an opportunity from someone who genuinely needs it.

Each application is carefully reviewed to ensure the funds are going to those who genuinely need support. We take this process seriously and it isn't about proving worthiness, it’s about making sure the generosity of others is honored and that help is reaching those who truly can’t afford to attend.

Please consider this carefully and apply only if you truly qualify.

Elegibilty requirments
- Must have a valid passport
- Must be at least 18 years old
- Must be able to afford all related travel expenses
- Must be able to contribute financially in some degree to the retreat program
- Must be able to demonstrate a commitment to your healing beyond attending this retreat
- Must be able to demonstrate financial need
- Must not have particiapted in an ayahuasca retreat or any other plant medicine retreat in the last two years.
- Must pass a medical screening
Please review our retreat pricing before selecting your desired discount to be sure you are able to cover all associated costs not covered in the scholarship.

Please select the the approprate scholorship amount that would allow you to realistically attend this retreat. We want to be able to award as many scholorships as possible and your honesty helps us not only help you but others seeking assistance as well.

Your answers are confidential.
Which scholarship opportunity are you seeking?*

25% Discount50% Discount75% DiscountOther
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age*
Which retreat dates would you be able to attend? (select all that apply)*

October 20 - 27 2025November 10 - 17 2025December 8 - 15 2025January 4 - 9 2026January 25 - 30 2026February 21 - 28 2026
Do you have any prior experience with ayahuasca?*

YesNo
Do you have any prior experience with any other psychedelics or plant medicines?*

YesNo
Please describe your previous experiences including when they were, and which medicines were used?
Are you currently employed? Select all that apply*

I own my own companyI have a careerI have a jobI am a studentI work part-timeI am unemployedI am retiredI am disabledOther
Please describe your current occupation:*
What is your average annual salary?

0 to $30,000$30,000 - $60,000$60,000 - $90,000$90,000 - $120,000$120,000 +
What is your average annual income?*
Do you have any debt?*

Yes - MedicalYes - Student LoansYes - Credit CardNo DebtOther
How much debt do you estimate?
What is your marital status?*

SingleDivorcedSeparatedWidowedIn A Relationship
What is your current housing status?*

I own my residenceI rent my residenceI live with familyI live with friendsTemporary HousingGovernment HousingOther
Do you have any children? *
Please select all that apply:

I am single motherI am a single fatherI have full custodyI have partial custodyI pay child supportI receive child supportI do not receive child supportMy children are grownMe and my partner are raising our child(ren) together
If married or in a long term relationship - what does your partner do for a living?
What do/did your parents do for a living? (If retired or deceased - what did they do when they were actively employed)*
Do you receive any of the following support/benefits?*

SNAPSocial SecurityVeterans BenefitsDisability BeneiftsNoneOther
Please provide online profiles: (Instagram, Facebook, TikTok, X, LinkedIn, Business page, Online article, etc.)*
For Facebook, please share your complete URL.
Please describe which financial barriers you face and why you are seeking financial support:*
Please tell us what practices you currently implement in your daily life or modalities you have tried in the past to support your healing:*
Please describe why you are interested in attending the retreat and what you are hoping to get from the experience? *
If you receive a scholarship, how do you envision your life after the retreat? What intentions or practices would you carry with you to support your return home?*
If selected, may we share your story with our community so they can see the impact that their donations have had in helping someone gain access to this experience and help inspire more donations to help others like yourself? (We will respect how much of your story you would like to share and which details you would like to keep private.)*

YesNo
Should be Empty: