Collaborence Scholarship Ticket Application

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Thanks for your interest in PATA's Collaborence event. We are offering 10 in-person scholarship tickets and 20 online access tickets for any individual who is not able to financially afford to attend.

In-Person scholarship tickets are available for $15, which covers lunch, and free for online access only tickets for out-of-area attendees.

We encourage anyone who self-identifies as being a part of an underrecognized community and/or who is financially challenged and would benefit from attending and contributing your voice.

We are placing no restrictions on who may apply and encourage everyone, regardless of their race, gender, sexual orientation, or religion to apply.

Tickets will be awarded on an ongoing basis while scholarship funds are available.

All information is confidential and will not be shared. Your name and email will be entered into our database, additional information provided below will not be retained or associated with your ticket if awarded.

Email *

Please provide your name *

How do you identify yourself within the community? *

Psychedelic Professional - Guide, sitter, integration specialist who is unaffiliated in the "underground".

Licensed OPS facilitator or facilitator student currently enrolled

Licensed Mental Health Provider

Other medical profession - Eastern, Western, or other

A Community Member interested in learning more about psilocybin

Other:

Please indicate which ticket type you are interested in: *

$15 In-person ticket for attendees in the greater Portland area - Ticket includes lunch.

Free online access livestream ticket for out-of-area attendees.

Do you identify yourself as coming from an underrecognized community or are experiencing financial difficulties that would otherwise prevent you from attending? We believe in honesty and are not placing restrictions or definitions on our requirements. *

Yes, I come from an underrecognized community.

Yes, I am experiencing financial difficulties.

Yes, to both above.

No, I am not from an underrecognized community or experiencing financial difficulties.

What do you hope to learn from the Collaborence? *

Thanks for applying!

We will review your application and get back to you via email shortly. If you have further questions, please email info@pata-us.org.

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