BIPOC Scholarship Application for Virtual Group Therapy Spring Conference April 28-29, 2022

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This scholarship program is meant for those who (1) self-identify as Black, Indigenous, or a Person Of Color and (2) are motivated to learn more about group therapy. It is open to students and professionals. It is intended to help cover the cost for those that would like to attend this conference but might not have the full financial means.

At this time we can cover the full ticket price for two professional tickets ($250/each) or five student tickets ($100/each). However, as we receive more scholarship donations we may be able to cover ticket costs for more BIPOC scholarship applicants.

Please answer the questions below and submit this form to complete your scholarship application.

We will be in touch shortly!

E-mailadres *

Email address (again) *

Your First and Last name *

Your professional status *

Student ($100 ticket price)

Professional ($250 ticket price)

Your current work setting *

Amount of scholarship money you would like to request *

My full ticket price

Other (I plan to pay for a portion of my ticket price, and I will enter that amount in the next section)

If you answered 'other' in the previous question, please enter the amount (in US dollars) that you would like to contribute toward your ticket price.

Briefly describe what is "calling you to" this Virtual Group Therapy Conference? *

Are you committed to amplifying fellow BIPOC voices within our conference sessions?

Yes

(Other) I have a different answer and will explain my perspectives further through an email with a member of the conference leadership committee.

Selectie wissen

Will you be wanting a CE Certificate?

Yes

Selectie wissen

(Optional) Please feel free to share anything else that you would like the conference leadership committee to know about you. :)

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