Accessibility Application Supreme Peace

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

At Supreme Peace we are dedicated to making our services accessible to dedicated individuals with a passion for learning.

Our accessibility options may include a mixture of:
1. Work Study: participants exchange their time and talents for some of the financial cost of their program.

2. Scholarship: part, or occasionally all, of the financial commitment for the program is waived.

Once you have submitted your application, someone will contact you within a week. If you do not hear from someone within a week, please feel free to email info@supreme-peace-yoga.com to discuss the next steps.

Email *

First Name *

Last Name *

Please specify which service you are interested in: (You may only select one service at a time. If you are interested in multiple services, please complete a separate application for each) *

Yoga classes (drop in, 10 class package or 30 class package)

Yoga membership (ongoing monthly)

Reiki training

Workshop

Yoga Teacher Training

Other:

Please describe your desire/interest in this service. *

How do you imagine participating in this service would impact your life? *

How do you imagine your participation in this service could be a benefit to your family, community, etc....? *

Please indicate which bottle you find yourself mostly in. (It's possible that you see yourself in several of the bottles -- do your best to pick the one that most describes your current circumstance.) *

Right bottle

Middle bottle

Left bottle

Prefer not to answer

Would paying for this service create a financial hardship for you in such a way that would prevent you from accessing your basic needs? *

Yes

Prefer not to answer

Other:

Which accessibility offerings are you interested in? (check all that apply) *

Work Study

Scholarship

Required

If you are interested in work study, how many hours are you available? (Please specify if this is weekly or monthly)

If you are interested in work study, what is your availability (please include the day(s) of the week and time(s) of day)

Diversity and Inclusion

This is an optional section to assist us in fostering diversity and inclusion within our programs. Our goal is to create opportunity for applicants who identify as Black, Indigenous, and People of Color (BIPOC) and/or members of the LGTBQ+ community. If you would like to share about your identity, please do so below.

I identify as Black, Indigenous, and/or a Person of Color

Yes, I identify as Black, Indigenous, and/or a Person of Color (BIPOC)

Clear selection

I identify as a member of the LGTBQ+ community.

Yes, I identify as a member of the LGTBQ+ community.

Clear selection

Thank you!

Thank you for your interest in services at Supreme Peace. Once you have submitted your application, someone will contact you within a week. If you do not hear from someone within a week, please feel free to email info@supremepeaceyoga.com to discuss the next steps.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms