The Rewilders Community Scholarship Application
* Required
Email address
*
Your email
Name (first, last)
*
Your answer
Preferred Name
Your answer
Phone Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender Identity (select all that apply)
*
Female
Male
Transgender
Non-binary/Non-conforming
Prefer not to respond
Required
Do you consider yourself to be:
*
Heterosexual or straight
Homosexual
Bisexual
Prefer not to respond
Other
Please indicate your ethnicity (select all that apply)
*
Caucasian
Latino/Hispanic
Middle Eastern
African
Caribbean
South Asian
East Asian
Native American
Mixed
Other
Required
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?
*
Your answer
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.
*
Yes
No
Do you have any disability or handicap that is long-term (lasting 6 months or more)
Yes
No
Clear selection
Please share what your intention is for participating in The Rewilding Community?
*
Your answer
What do you hope to contribute and gain from participating in this program personally and if applicable professionally?
Your answer
Is there any additional personal information would you like to share?
Your answer
A copy of your responses will be emailed to the address you provided.
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