Financial Info

Our normal scholarship contribution is ½ off the price of the workshop. If your application is approved, are you able to pay the balance immediately?

YesNo

If not, what can you afford to pay at this time?

Please describe your current financial situation and what are you actively doing to improve the situation.

Have you been granted a scholarship in the past? Are you interested in paying into the fund for scholarships to help someone in the future?

Please describe other means you have explored for financial assistance (i.e. asked a friend, picked up shifts).

What would you like to do in exchange for a scholarship? e.g. Bring paying guests to the workshop? Promote? Other?

Personal Info

Full Name

Address

Email

Phone number

Occupation

Marital Status

Number of children

Event Info

What is the name of the workshop would you like to attend?

Date of workshop

Location of workshop

Have you attended any of Derek’s workshops in the past?

YesNo

If yes, when did you last attend (approximate month/year)?

How did you hear of Derek?

Your Situtation

What is your motivation for wanting to be at this workshop?

Is there a particular area of your life that needs healing at this time? If so, what benefit do you feel you will receive from the workshop?

Is there anything else you would like to share with us regarding your application?

Thank yourself for completing this application. We appreciate the time you have taken to tell us about yourself and honor your commitment to serving your highest good by attending a workshop with Derek O’Neill.

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