Soltara Healing Center Partial Scholarship Application
Please complete the form below to apply for a partial scholarship to one of our upcoming retreats. We will follow up with you via the email below.

**Note - Please only submit an application for retreats you could feasibly be able to attend. If none of the listed dates work for you, please check back later, or keep an eye on our newsletter for when new dates are made available. Thank you so much!**
Sign in to Google to save your progress. Learn more
Email *
In order to be chosen as a scholarship recipient, please subscribe to our newsletter by clicking this link.
First Name *
Last Name *
Gender *
Country *
Birthdate *
MM
/
DD
/
YYYY
Ethnicity *
Required
Additional Indentity
Have you worked with ayahuasca plant medicine before? *
Please select which retreat dates you are able to commit to for this scholarship. *
Please note that confirmation for a retreat is based on our assessment of the safety of this experience for you through our intake process. Soltara reserves the right to kindly decline your registration if our intake support team determines a retreat with us is not a good fit for you at this time.

Please Note: If you are currently taking SSRI's or have a serious medical condition or diagnosis that requires medication, please reach out to us directly first at peru@soltara.co, as it is possible that we may not be able to safely confirm you for an upcoming retreat due to contraindicated medication timelines.
Required
Which level of scholarship are you needing? *
You may select more than one. You can view pricing by clicking into each retreat program option and/or dates on our retreats page. Lodging options for the above retreat dates are subject to availability.

Note: Please include the minimum amount of scholarship that would facilitate this experience for you. This allows us to award as many scholarships as possible for others, and increases the chances that we will be able to support you and the rest of our community.
Required
What has brought you to the medicine and the desire to attend an ayahuasca plant medicine retreat at Soltara? *
If you are awarded a partial scholarship, may we share any or all of your above story with our community? *
We respect your privacy and the intention for this is to support the rest of the community in knowing they are not alone. We will not share anything you are not comfortable with, and will follow up with you directly if you are open to sharing.
If you would like us to tag you if/when we share your story, please let us know your profile handle or name and which platform it is for (IG, Facebook, etc.)
Please share your reasons for applying for this scholarship. *
This information will remain confidential and is for internal purposes only, to help us understand the circumstances for your application.
Is there anything else you'd like us to know?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy