Scholarship Application

Use this form to apply for scholarships to The Learning Well classes and workshops.

Name(Required)

First Last

Date(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter the name of the workshop you'd like to attend.(Required)

You may apply for a full or partial scholarship to one workshop each award period.

Financial information

We provide scholarship funds based on financial need. If awarded a scholarship, you will have six months to use it. The scholarship cannot be transferred to another person. We ask that if you receive a scholarship, you complete an evaluation of the workshop to help us continue to provide a great experience for participants.

Family income range(Required)

$10,000 to $20,000 annually

$20,000 to $40,000 annually

$40,000 to $60,000 annually

$60,000 or more annually

Number of dependents in your family

Anything else you would like us to know?

Signature

CAPTCHA

Financial information

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