ScholArship Application Name * First Name Last Name Email * Phone * Country (###) ### #### Website http:// Date of Birth * How did you hear about us? * Month(s) of the retreat(s) you would like to attend * Scholarship goal * 20% 50% 80% Partial payments * 1 2 3 Please tell us more about your situation. What do you want to get out of your retreat? Why would you benefit from a scholarship? Would you like to offer any collaboration exchange? * How has your experience with plant medicine been so far? * How would you describe your overall health? Do you have any medical conditions? * Are you currently taking any prescription drugs? * Have you ever been diagnosed with schizophrenia or any mental health disorder? * Do you have any allergies or food restrictions? * Thank you!
