Scholarship Application | Rohini Ross
 

Scholarship Application

Please complete your scholarship application by filling out the form below.

    Dear Applicant,

    Thank you for applying for tuition assistance to attend the Soul-Centered Series 7-month program beginning October 11th, 2019 in Santa Monica, California.

    Your responses below will help to determine how funds are allocated. Tuition assistance is for in-person participants with financial hardship only. Proof of income will be required. The intent of tuition assistance is to foster the group being an economically diverse and multicultural group of participants that will enrich the experience of everyone involved.

    With loving,

    Rohini

    Applicant Information:

    First Name: Last Name:
    Preferred Name:
    Address:

    Street: City, State, Zip Code:
    Country:
    Phone Number: Email:
    Date of Birth:

    Gender: MaleFemaleNon-binary
    Self-identified: Gay, Lesbian, Bisexual, Transgender or Queer


    Do you have a physical or other type of need that requires attention or accommodation during the course? YesNo
    If yes, please describe.

    Ethnicity: Hispanic/ LatinoNon-Hispanic/Latino
    RaceWhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderMixed-RaceOther (please indicate)
    If Others

    I am from a rural background: YesNo
    I am a US Veteran:YesNo
    I am a Mental Health Professional: YesNo
    I am committed to working in disadvantaged communities upon completion.: YesNo

    Do you come from an economically disadvantaged background as defined below?

    Economically Disadvantaged means an individual comes from a family with an annual income below a level based on low-income thresholds according to the U.S. Census Bureau.

    2018 POVERTY GUIDELINES
    Family Income level
    1 ...................................................... 24,280
    2 ...................................................... 32,920
    3 ...................................................... 41,560
    4 ...................................................... 50,200
    5 ...................................................... 58,840
    6 ...................................................... 67,480
    7 ...................................................... 76,120
    8 ...................................................... 84,760
    For families with more than 8 persons, add $8,640 for each additional person.

    I am economically disadvantaged based on the above criteria. YesNo
    If you answered no to the above question, please include your household’s annual income and the number of people this income supports:

    How much are you able to contribute to the program either personally or through fundraising?
    What is the amount of scholarship you are requesting to cover the cost of the program?
    Are you able to cover transportation and, if applicable, lodging that would allow you to attend the program?

    1. List any 3 Principles trainings you have completed

    2. Please share what your intention is for participating in The Soul-Centered Series?

    3. What do you hope to gain from participating in this program personally and if applicable professionally?

    4. How do you intend to share what you are learning with others?

    5. What additional personal information would you like to share?

    I certify that all information provided on this application is complete and accurate to the best of my knowledge.
    Date of application:

    Scholarship due date is September 6th, 2019. Decision notifications will begin being sent September 13th, 2019.