Vallecitos Scholarship Application

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1 Welcome

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First Name *

Last Name *

Email *

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2 Applicant Information

Please be sure to complete BOTH this scholarship application as well as complete the registration form for the retreat you wish to attend. We cannot process your scholarship application until you are registered for a retreat.

Please Note: Scholarship funds can only cover retreat fees (lodging and meals). Scholarship funds do not cover transportation costs, shuttle service, comfort pack, or dana. Please keep this in mind when budgeting the amount you are able to pay towards your retreat fees.

Phone *
City *
State *
Which retreat are you applying for? *	Please list the name of the retreat. You must be registered for a specific retreat before we can process your scholarship application.
What is your gender pronoun? (optional)
Are you a person who identifies as BIPOC (Black, Indigenous or Person of Color)? (optional)	Vallecitos only asks this question to know if you are eligible for specific BIPOC Scholarship funds.
Do you identify as an immigrant? (optional) We ask this question because we care to support immigrants and acknowledge the vulnerability of many immigrants at this time.
Do you work in social or climate justice, public service, social service and/or education?	We ask this to support those who have dedicated themselves professionally to service-oriented fields.
Is there other pertinent information with regard to your identities that you would like us to know? (optional)	We care to support a multiplicity of identities having access to practice at Vallecitos.
Please indicate the level of support you need: *	25% of your retreat fees 50% of your retreat fees If these options remain prohibitive to attending retreat, please let us know in the last question.
We would appreciate in a sentence or two understanding why you are seeking financial assistance. *

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