Scholarship Application

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* These fields are required

1 Welcome

2 People in your group

3 Applicant Info

Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Please select the option that broadly characterizes your diet.	There is a field below where you can share specific dietary needs, such as allergies & intolerances or variations such as pescatarian (eats fish but no other meat) or no pork/red meat.
Please share any food allergies you may have.	Please note that we make every effort to accommodate each person's dietary needs but highly specific diets may be outside of our ability to serve. We are not an allergy-safe kitchen.
Special Needs (ADA / Accessibility)
Emergency Contact Name	Please list the name for someone who we can contact in case of emergency during your time on retreat.
Emergency Contact Phone Number

4 Request Details

5 Security Check