Scholarship Application & Coaching Intake

Our scholarships are made possible by our generous donors. At times, our funds may be limited. An application does not mean that you are automatically approved.

Please complete the information below to the best of your ability. We will be in touch with you soon to let you know if you have been approved.

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

Postal code *

How did you hear about us? *

Referred by Agency

Referred by Person

Facebook

Instagram

Linked In

Other

If other or referred, please tell us by who.

What coaching services are you interested in? *

Abuse Recover Coaching

Parenting Coaching

Relationship Coaching

Financial Coaching

Health Coaching

Business Coaching

Wealth with God

Girl's Trip

Let us know a little bit about why you are seeking a scholarship.

We also offer a sliding scale fee based on your income. If your income is below $25,000 we charge $30 per session. If your income is between $25,000 and $40,000, we charge $40 per session. What is your income category? *

Under $25,000
Between $25,000 and $40,000
More than $40,000
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Income Documentation: If applying for a scholarship, please upload your income documentation using the button below. If you are paid every two weeks or twice a month, please upload two pay stubs. If you are paid once a month please upload one paystub.

What result do you hope to get from coaching or the program you are interested in? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Questions or Comments?

Thank You!

Thank you for providing your information. We will review your submission and call you if we have any questions or need any clarification.