Six Month Wellbeing Journey Scholarship Application

The deadline to apply is December 19, 2022, at midnight CDT. Selected applicants will be notified in December 2022.

"*" indicates required fields

Please fill out the following information below

Application Date*

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

How did you hear about the scholarship?*

Your Income Range*

Education

Name of High School

Did You Graduate?

Graduation Year

Name of College

What Did You Major In?

Did You Graduate?

Graduation Year

References

Please provide two references (colleagues, managers, friends, teachers, etc.) No family members, please.

Full Name*

Relationship to You*

Company or School (if applicable)

Email*

Phone

Full Name*

Relationship to You*

Company or School (if applicable)

Email*

Phone

Goals

Why are you interested in holistic health?*

What has been the biggest hurdle about your health lately?*

What are your greatest financial needs at this time in your life?*

Describe what life looks like on a daily basis for you - and generally how you feel about it.*

Are you part of any community service groups or projects? Please list and describe your role in each one (if applicable).

What does your support system look like? In other words, do you have people who know how to lift you up?*

Looking ahead, what would you like to see change six months from now?*

Would you be open to sharing your experience at the end of the program on video or in writing? Your story will be used to encourage and inspire future applicants.*

Final Section

Provide three reasons you should be selected for the Big Shifts Foundation Scholarship Program.

Agreements, Consent and Signature

If I were to receive this scholarship, I agree to...

Consent*

I agree to be truthful in my answers on any paperwork I fill out during this process.*

Consent*

I agree to commit approximately three hours/month for six months to this program to improve my well-being.*

Consent*

I agree to contribute $25/month (or $150 one-time fee at the beginning of the program) to cover a small percentage of the program’s costs (such as blood/lab panel, appointments with practitioners, and vitamins/supplements).*

Consent*

I agree to attend orientation and to make my monthly appointments with practitioners as outlined in my wellness plan.*

Consent*

I agree to complete the scholarship paperwork and submit it back to the Big Shifts Foundation team.*

I certify that my answers are true and complete to the best of my knowledge. I commit to attending and completing this six-month program.

Signature*

Today's Date*

Comments

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