Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Scholarship(s) to which you are applying. *

The Fellowes Scholarship Award (FULL SCHOLARSHIP)

The Ted Zajak Jr. Award( FULL SCHOLARSHIP)

The IMPACT Award (PARTIAL SCHOLARSHIP)

The Culver Award (BARTER PARTIAL PROGRAM)

Do you work in any of the following fields? *

Please click all that apply.

Medical Professional

First Responder

Therapists

Social Worker

Educator

Military or Veteran

None of the above

Diversity: The practice of yoga is non-harmful by nature and tradition. As such, Awake To My Soul is non-discriminatory in all practices. Your answer to the questions below will help the scholarship committee get to know you and what you will bring to the Launch YTT community. Any and all information shared will remain confidential. Within the community, do you identify as an under-represented minority in any of the following categories?

Race/Ethnicity

Yes

No

Prefer not to answer

Religious/Spiritual Identity

Yes

No

Prefer not to answer

Age/Generational

Yes

No

Prefer not to answer

Sex

Yes

No

Prefer not to answer

Gender Identity

Yes

No

Prefer not to answer

Sexual Orientation

Yes

No

Prefer not to answer

Physical Ability and Disability

Yes

No

Prefer not to answer

Mental Ability and Disability

Yes

No

Prefer not to answer

Socioeconomic Status

Yes

No

Prefer not to answer

Highest Education Level

High School

College

Prefer not to answer

Immigrant/Nationality

Yes

No

Prefer not to answer

I certify that all of the above information is true. I understand that this information will be used in determining scholarship awards and will be kept strictly confidential. If I receive a scholarship, I commit to completing evaluation(s) and fulfilling all graduation requirements. *

I certify my agreement with the statement above.

We love to hear your stories! *

Yes, if granted a scholarship, I would be willing to talk to an Awake To My Soul representative about my experience. I understand that my response here will in no way impact a decision about my application.