The Liberated Clinician Scholarship Application: Spring 2024 Cohort
The Liberated Clinician is rooted in social justice. That means making the course accessible to a broad range of people, including those who don’t have the financial resources to pay for it. To do this, I am offering several partial and full scholarships to individuals experiencing financial hardship.

The application deadline is Friday May 3rd at 11:59pm EDT. **Due to the limited number of scholarships available, if you are selected for a scholarship, you will have 24 hours to confirm to secure your spot in the program.**

Review the scholarship eligibility criteria considerations here before filling the application out: https://bit.ly/3uUBoOQ

To apply, complete the application below.
Sign in to Google to save your progress. Learn more
First and Last Name: *
Email: *
Pronouns: *
Location in the world: *
What best describes you professionally? *
Because scholarships are limited, my aim is to prioritize applicants based on intersectional needs. Please share any relevant aspects of your identity (i.e. BIPOC, neurodivergence, LGBTQ+): *
What sparked your interest in participating in The Liberated Clinician? *
What do you hope to get out of The Liberated Clinician? *
Please describe the type of business you have or want to start. How long have you had your business and at what capacity (full-time/part-time)? *
What is your annual income (dollar amount)? *
The true cost of The Liberated Clinician is $2994 (payable over 6 or 12 months). Would paying this sum be a financial hardship for you? *
What amount are you willing and able to pay PER MONTH for 12 months (please list dollar amount per month)? *
Our Group Coaching Calls take place on Wednesdays at 1PM EDT. Would you be able to make these calls? (This will not determine your eligibility for a scholarship - just helpful for us to know.) *
Please share with me any other information you feel is important in considering you for this scholarship.
I acknowledge that by ticking this box I am applying for a scholarship for The Liberated Clinician. If I opted for a partial scholarship, and my application is approved, I will be sent a link to pay the deposit and set up the payment plan to secure my spot and will do so within 24 hours. *
Thank you for your honesty and vulnerability. I value your privacy and will not share this information with anyone beyond myself and my immediate team.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms