Chronic Wellness Scholarship Application
Please note that clients who are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) and are able to provide proof of income may be eligible for reduced and sliding scale fees.

For a select few who demonstrate both financial need and extraordinary commitment to their health and wellness goals, it is my privilege to offer full and partial scholarships to a number of my coaching programs.

Please fill out the form below to apply and I will contact you within 24 hours with a response.

Email address *
Name *
Your answer
Phone number
Your answer
Are you currently employed? *
If yes, where are you working?
Your answer
If not, are you receiving supplemental income?
Have you ever applied for Social Security disability insurance because of your condition? *
Please select your average monthly income: *
How much are you able to budget for health coaching each month? *
What improvements would you like to see in your health three months from now? *
Your answer
What effect would it have on your life to reach those goals? *
Your answer
On a scale of 1 to 10, how committed are you to apply what you learn and follow through over the next three months? *
Not at all committed.
Extremely committed.
On a scale of 1 to 10, how willing are you to implement positive lifestyle changes over the next three months? *
Not at all willing to change.
Extremely willing to change.
On a scale of 1 to 10, how resourceful are you ready to be to achieve your goals over the next three months? (This includes securing the necessary finances, tools, and partners.)
Not at all resourceful.
Extremely resourceful.
Who are your strongest supporters right now? *
Your answer
Finally, what is the number one reason you feel that you would be an excellent candidate for this scholarship? *
Your answer
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