The Rewilders Community Scholarship Application
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Email *
Name (first, last) *
Preferred Name
Phone Number *
Date of Birth *
Gender Identity (select all that apply) *
Do you consider yourself to be: *
Please indicate your ethnicity (select all that apply) *
The monthly fee for the Rewilding Community is $39 USD/month. It is a month-to-month subscription payment. How much can you afford to pay per month in order to participate? *
 Please answer yes or no to indicate whether you are economically disadvantaged based on the criteria below.  Economically Disadvantaged means an individual comes from a family with an annual income below a level based on low-income thresholds according to the U.S. Census Bureau.                                                         *
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Do you have any disability or handicap that is long-term (lasting 6 months or more)
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Please share what your intention is for participating in The Rewilding Community? *
 What do you hope to contribute and gain from participating in this program personally and if applicable professionally?
Is there any additional personal information would you like to share?
A copy of your responses will be emailed to the address you provided.
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