Wholistic Healing Experiences Scholarship Application Form
Thank you for your interest in our program.

My heart to reach everyone who needs work inspired me to develop a program where instead of receiving gratuities from clients, I offered them an opportunity to give forward to someone else and the scholarship program began in Nov 2016.

Scholarships are awarded in a combination of first come, first served and needs based based on funds availability. All scholarships are based on funding available and awards may be given in full or partial amounts as such.

Applicants are eligible to resubmit an application if you experience a change in circumstance (health status change, financial change i.e. loss of job due to health issues) otherwise your initial application will be kept on file and you will be notified as soon as you are selected.

Email address *
Today's Date *
Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
How did you hear about the scholarship? *
What is your daily pain level? *
Not very
Very much
What is your daily stress level? *
Which best describes your financial ability to pay for services on your own? (Select all that apply) *
Other than finances, is there anything that is preventing you from scheduling an appointment now? *
Your answer
Briefly tell me about the physical issues that you struggle with that have contributed to your pain and stress. *
Your answer
Tell me about your spiritual health. *
Have you experienced a life changing event recently that has caused a negative impact on your overall health? Please briefly explain.
Your answer
What are your goals for receiving bodywork? *
Your answer
How would you like to be notified once your application has been reviewed? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service