Financial Assistance Application Form for LES Deeper Roots Immersion Program
Please FULLY complete this form to be considered for financial assistance in the 2023-24 program. 

If you have ANY questions or problems with the scholarship application process, please email Anna at connect@livingearthva.org or call 434-260-0086. We're happy to help out!
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Participant Full Name *
Best email *
Best phone number
Please describe your situation and need for financial assistance.
How much are you able to pay in order afford this program?
 *
Annual Household Income
 *
How many people currently live in your household?
Anything else that we should know to help us in our decision?
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