Scholarship Application
First & Last Name *
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Phone Number *
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Street Address *
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City *
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Zip Code *
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Email *
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Classes
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)

Which class are you applying for? *
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Is there any cost you can cover? If so, how much are you able to pay? *
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What is your financial situation? *
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How will this service impact your healing? *
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Anything else you would like to add:
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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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