January Cohort | Healing Conversations Scholarship Request

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Thank you for your interest in the January Healing Conversations Course!

For students, laid off workers, anyone who doesn't have access to a professional development budget, or if your currency exchange rate is at an extreme difference with the US dollar (e.g. India, Brazil, etc) please fill out the form below to and someone on our team will get back to you on Friday January 14th to inform you if you have were selected for a limited number of discounts that we have available!

Your Full Name *

Your Email Address *

Where are you currently located? *

I identify as someone who: *

Please select all that apply

Is a student

Was laid off or furloughed

Doesn't have access to a professional development budget from my employer

Has a currency exchange rate that is at an extreme difference with the US dollar

Is an underrepresented racial/ethnic minority

Has a disability

None of the above

Required

Most recent employer: *

If you're a student, please write what school or program you are attending.

If unemployed or furloughed, please write your last date of employment. *

Write N/A if not applicable.

I understand that my eligibility for this scholarship is conditioned on the accuracy of the information I have provided. *

Write N/A if not applicable.

Yes

Submit

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