Learn Reiki Philadelphia Financial Assistance Form

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Thank you for your interest in our classes & workshops! We are a very small business. This form helps us to allocate resources, invite as many folks as possible and gauge the impact our assistance has. The last question is open ended, allowing you to add anything you feel is relevant that we may have overlooked. If something feels too personal, you may absolutely leave it off. Thank you for your time and feedback, we hope to see you soon!

Email *

Name & Pronouns (she/he/they etc) *

Phone

How did you first hear of my programs? *

Which class(es) or workshop are you interested in? *

Is there a specific date of the class or workshop you seek to join? If so please include here

We can structure a payment plan for the balance. If this would be helpful, what could you pay, and how often? Payment plans do not cost extra.

If you are applying for a Reiki class: these are offered on an ongiong basis. Aid may be more readily available if you are flexible about when you take the class. I am often available for classes on: (Please select all that apply)

Weekday Evenings

Weekday Daytime

Weekends

I need at least 2-3 weeks notice to join a specific class

I need at least 5-7 days to join a specific class

I am (please check all that apply) Please note: if none of these apply to you, that does not disqualify you from financial assistance

Unemployed or working reduced hours

In school

A single parent

Black, Indigenous or Person of Color (BIPOC)

An immigrant or refugee

LGBTQIA+ and/or of non-binary experience

Handicapped and/or disabled (seen or unseen)

Estranged or separated from family

Employed by a charitable organization or community based initiative

On some form of public assistance

How much assistance do you need in order to attend? *

25% reduction

50% reduction

75% reduction

I am interested in this course for *

Personal growth & development

Professional growth & development

Both personal & professional enrichment

I'm not sure yet, but it feels important

What interests you about this subject? *

How do you hope this class or workshop will impact you? *

Do you have interest or experience in other holistic/wellness/spiritual pursuits?

Do you have a long term goal that this class or workshop could help you achieve?

In your personal (non professional) life, are you involved with improving your community in any way? (examples include helping neighbors, engaging policymakers, volunteering, etc)

Is there anything else you would like to share about yourself, your situation or how this could help you, your family or community?

If you are applying for assistance with Reiki level 2 or higher only: When and with whom did you study your previous levels? Was this a different style than Usui Reiki?

A copy of your responses will be emailed to the address you provided.

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