Be Well Beautiful People Support Application

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Thank you for applying for upto full based scholarship to the Ink Your Liberation Writer's Retreat! This enriching day will be led by our founder Demarra West and author of Me Too: A Therapist’s Journey to Heal, Find Liberation, & Joy.

We are committed to making this retreat accessible to those who need it most. Scholarship notifications will be sent by September 7. If you have any questions or need further assistance, please don’t hesitate to reach out to jem@bewellbeautifulpeople.org.

We’re excited to support your journey and can’t wait to welcome you!

Be Well Beautiful People Team

Email *

Name *

Contact Number *

Email Address (please note we'll add you to our e-news)
*

Home Address *

What companies(s)/organization(s) are you affiliated with?
*

Please indicate any categories that relate to you:

(Check all that apply)

BIPOC

LGBTQI

Low Income

Impacted by the Foster Care System

Impacted by the Criminal Justice System

Required

Why do you want to attend this retreat?

How would receiving this scholarship help you make the most of the retreat experience?

What do you hope to get out of the experience?
*

Have you ever attended a writer's retreat before?
*

Yes

If so, what did you like, dislike about the retreat(s) you've attended?

Current Mental Health Status
Please describe your current mental health status:
*

I am currently in good mental health.

I am experiencing mild mental health challenges (e.g., stress, anxiety).

I am experiencing moderate mental health challenges (e.g., ongoing anxiety, depression).

I am experiencing severe mental health challenges (e.g., significant depression, severe anxiety).

I prefer not to disclose.

Are you currently receiving support for your mental health? (Please answer if applicable)
*

I am actively receiving mental health support (e.g., therapy, counseling, medication).

I have previously received mental health support but am not currently engaged in any treatment.

I am seeking mental health support but am not currently receiving it.

I am not currently seeking or receiving any mental health support.

I prefer not to disclose.

How did you learn about this retreat?

Social Media

Email Newsletter

Word of Mouth

Website

Event Flyer

Please share anything else you feel is important for us to know.

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

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