Scholarship Application

Open Dates

* These fields are required

1 Price

$50.00 – Fee

2 Participant Info

First Name *
Last Name *
Email *
Phone *
Title of retreat application is for *
Date of retreat *

3 Scholarship Criteria

Scholarships are evaluated according to the following three criteria:

• Serious or life-threatening medical problems causing financial hardship;

• Enrolled students without the resources to pay in full;

• Other serious financial need.

Please describe your situation for the committee as best you can in the space below.

Description of Financial Situation *

4 Payment

Sub Total	$0

Taxes	$0

Due Now	$0 $0

First Name
Last Name
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card