Scholarship Application
First & Last Name *
Phone Number *
Street Address *
City *
Zip Code *
Email *
Which class are you applying for? *
Ultimate Journey
Please note below the pricing for Ultimate Journey - Scholarship does not cover the price of the book.

Ultimate Journey Phase 1 $175 ($50 for book to be paid by participant)
Ultimate Journey Phase 2 $100 ($50 for book to be paid by participant)
Ultimate Journey Phase 3 $100 ($50 for book to be paid by participant)

Four Month Resident Stay
The full amount for the Resident Stay is $1,000 ($250 per month)
Please indicate what amount of the cost you can cover.
Classes
Classes typically range $15-$35 for the entire class.
Is there any cost you can cover? If so, how much are you able to pay? *
What is your financial situation? *
How will this service impact your healing? *
Anything else you would like to add:
If you have not registered for your class, please follow the link to get signed up.
Contact Us:
www.houseofhopecr.org
mail@houseofhopecr.org

319-366-4673

1744 2nd Ave. SE
Cedar Rapids, IA 52403
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