SPECIAL CONSIDERATION: REQUEST FORM
We are excited about the Seattle Fall Ball and want to work with any couple who has special circumstance that may prevent them from attending the Seattle Fall Ball!  There is no judgement as we know everyone has their situation depending on their Season of Life, including us!

Simply fill in the info below and submit ASAP to see what can happen!  Scholarships are limited and so is the space in the ballroom so please don't hesitate.

PLEASE NOTE: If you have NOT completed the Official Seattle Fall Ball Registration form for 2019 please take a moment to do that BEFORE filling out this Special Consideration Form.  Payment plans and partial scholarships are considered only for REGISTERED Seattle Fall Ballers! If you are approved for a Partial Scholarship or payment plan we can not document your award or plan with out your registration complete and therefore will offer to the next person on the list.

if you haven NOT registered yet please go directly to the Seattle Fall Ball Official Reservations and make your reservation first and then come back to this form. 

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YOUR INFO
Registration Status *
Have you officially registered for the ball?  Consideration is given to the registered only.
Married? *
Please specify.
Your Name? *
(First & Last)
Your Spouse's Name? *
(First & Last)
Your Contact #? *
The best number to reach out you. We prefer cell phone in case we need to text you.
Your Email?
The best email to reach you at.
YOUR REQUEST:
Please check yes or no for each area of need listed.  Please keep in mind that resources are limited.

Please only request a partial scholarship only if you absolutely can't pay the full amount even with a payment plan.  If a special payment plan could help make it possible to pay the full amount please click on the payment plan option. If you need both you can click on both.

After selecting yes or no below please continue to fill out the rest of the form based on the option(s) you selected. No payment plan or scholarship request is guarantee.
Yes
No
Partial Scholarship
Payment Plan
Clear selection
Partial Scholarship Need
IF you clicked yes requesting a partial scholarship, please let us know the following:
Past Scholarship?
Please let us know if you received a scholarship in the past.
Clear selection
How much can you afford?
Unfortunately we do not have the capacity to give full scholarships at this time.  Please share how much you can honestly pay toward your ticket. All scholarships are contingent on the available of the resources at the time of request. This is a good faith process.
Circumstances?
Any details that you can share to help us understand your need. All information is kept confidential and used for making consideration with limited resources. This is a good faith process.
Payment Plan Need
IF you selected yes to request a payment plan, please let us know
How much you can pay now?
IF you selected yes to request a payment plan, please let us know how much you can pay now and when you can make the initial payment.
What installments would work best?
IF you selected yes to request a payment plan please specify the dates and how much you can comfortably pay on each date after your initial payment, if the plan is approved.
Thank You For Your Submission!
We process applications for payment plans and scholarships as often as we can but sometimes there are delays. Feel free to reach out any time if you have questions or to check your status. Please text or call 206.992.6857 (ask for Heidi) or 206.992.6856 (ask for Terrence) or info@TheBlackMarriageMovement.org! Please don't send an inbox on social media as it is complicated to monitor all the communication streams.

Chat with you soon!

Terrence Lewis and Heidi Henderson-Lewis
Co-Founders, The Black Marriage Movement/Seattle Fall Ball
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