JACINTA V. WHITE
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Please complete by March 14! This scholarship is for the Rooted Tier which includes full access to live sessions, workbook, playlist, embodiment practices, recordings, and community chat with inspired messages, but does not include 1:1 coaching.
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Name
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First
Last
Pronouns
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Race/Ethnicity
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Email
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City/State/Country
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Age
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21-30
31-40
41-50
51-60
61-70
other
What inspires you to want to be a part of this program? What are you hoping to learn/experience?
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What hardships or situations lead you to request a partial scholarship?
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How much are you willing and able to pay for this program, regularly priced at $199?
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$99
$50
$25
How did you hear about this program?
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Facebook
Instagram
Email
A friend
Other
By placing your initials below, you are acknowledging that this program is not and does not take the place of therapy and in no way should be a substitute to medical/mental professional help/support.
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By placing your initials you understand that as a scholarship receipent it is asked and expected that you participate in most if not all of the live sessions.
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Any other comments?
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Thank you for taking the time to complete this form. Notifications will go out no later than March 18.
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Home
Classes/Convenings
>
Rise Rooted
Coach
Consultant
Creative
>
Poetry
Books
Cards
Publisher
Celebrant
Shop
Contact