ECA Medicine Retreat Scholarship Application

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

The ECA retreat scholarship position is for one individual per retreat who is in dire need of the medicines and would otherwise be unable to attend. This is a partial scholarship. Recipients pay for their flights or transport to Colombia, and contribute monetarily based on their financial situations.

Please consider and respond to the following questions in order to apply.

Email *

Full Name *

Age *

Gender *

Female

Male

Prefer not to say

Other:

Nationality *

Best way to contact me for Video Interview *

Skype

Google Hangouts

Skype / WhatsApp / Google Hangouts contact details *

If you selected WhatsApp, please include your country code.

What has led to your desire to study the ancestral medicines and traditions of the Americas? *

Do you have any specific physical health concerns at this time? *

How would you describe your current internal emotional and mental states? *

Please tell us about your current form of employment or professional pursuits /passions: *

Please provide detailed information regarding your current financial status and any supporting screenshots or documentation. *

Anything else that you would like to share with us as we consider your application?

Send me a copy of my responses.

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