BLTT Scholarship Application
Please fill out this application to apply for the Brain Longevity® Therapy Training scholarship. We will respond within 2 weeks. If you have any questions, please email Dr. Cathy Watkins, Scholarship Ambassador and Coordinator at drcathy@alzheimersprevention.org. 
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Email *
First/Last Name *
Preferred pronouns
Preferred way to be addressed *
Phone number *
Full mailing address *
How did you hear about this Scholarship? *
Profession *
Employer *
Title and degrees held *
Credentials to appear on your certificate (i.e. RYT, RN, OT, LMT, etc) *
Since ARPF will grant one scholarship to an individual so that we can build a mutually beneficial relationship serving a target population of older adults and individuals at risk, please describe how you see ARPF and you successfully working together to reach this goal. Please give specific examples if possible.
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Please describe what underserved groups you intend to work with that you believe would benefit from the BLTT program.

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Please describe in detail your current community based advocacy or educational outreach work. 

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Please indicate with specific details how this training will enhance the services you already provide to the community, if applicable.
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If awarded this scholarship, do you agree to recognize and acknowledge ARPF at your presentations and to let us know where you speak/teach? ARPF would like to know the impact of the scholarship and to recognize your work in our publications.

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Can you commit to complete the course in 4 months?
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Do you agree to participate in monthly Peer to Peer sessions and webinars, and network with the other participants, as much as possible?
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Do you agree to submit a video testimonial about your experience and what you have learned during the BLTT?  (Video will be utilized for marketing purposes)

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Is there a tentative timeline of when you might implement this training? Please describe your timeline. 

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Do you agree to share ARPF material and re-post our social media information on your social media channels (if you have social media)? 

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Please provide any additional information about your household's socioeconomic status or circumstances that you would like us to consider when evaluating your application.

If a full or partial scholarships are filled and thus unavailable for this cycle, are you interested in work exchange instead?

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