Welcome, I'm so glad you're here.

Please fill out this scholarship form and we'll be in touch with you by Friday, October 22 if not before. Thanks for your interest in Grieve & Glow.

Name

First Name

Last Name

Pronouns

What's your address? (I sometimes send gifts!)

What are you grieving?

What are your biggest challenges in life right now?

Tell me about who you would like to be at the end of this program. What kind of a person do you want to become?

What is your relationship with your body like? With your pussy? (if you don't identify with the word ‘pussy’, then the energy of your genitals)

What other modalities or practices have you interacted with to help you reach your goals? Do you have a daily practice?

If you have undergone therapeutic treatment for any of the following: bi-polar/manic depression; post-traumatic stress; clinical depression; eating disorders; and/or suicide attempts, please share any details you'd like for me to be aware of below.

I stand in solidarity with all people from marginalized communities and work with clients who do as well. Are you doing anti-racism, LGBTQI+ or other diversity and inclusion work to expand your learning, overcome bias, understand privilege and advocate for these communities?

Are you on board to help make this a safe and confidential space for all womxn?

Yes

What can I do to help make you feel comfortable during this program?

Tell me a little bit about your financial situation and how a scholarship could help out.

Do you have support systems in place and/or coping mechanisms that help you get through hard times?

Yes

I am passionate about making sure my program is accessible for everyone. Do you have needs or considerations that I need to be aware of to ensure your success?

How did you hear about this program?

Is there anything else that you would like to share with me?

Are you applying for a full or partial scholarship?

Full

Partial

Welcome, I'm so glad you're here.

Sara Chizek