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Certificate in Community Storytelling Application
Michele Neary
2020-07-17T09:56:14-07:00
Tuition Assistance Application for Certificate in Community Storytelling
Name
*
First
Last
Email
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
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District of Columbia
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Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
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U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
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ZIP Code
Phone
*
What organization or community do you represent?
Please tell us a little bit about who you work with, either in your profession, your volunteer life, or your personal transformational work.
How do you plan to use this training? What are your goals?
*
Please tell us in a few sentences how you will apply your learning in your community, organization or family systems.
How will this training benefit your community or organization?
*
Please tell us in a few sentences the outcomes you hope to see as a result of using storytelling in your community, organization or family system.
Is your county of residence considered rural?
*
Note: definitions of "rural" may vary by region.
Yes
No
Not sure
What is your age group?
*
under 21
21-30
31-40
41-50
51-60
61-70
70+
What is your identified race/ethnicity?
*
What is your identified gender?
*
Do you identify as LGBTQia?
*
Yes
No
Not sure
Are you a representative of a traditionally underserved population?
Yes
No
Not sure
Do you have any ability to pay a portion of the tuition payment?
*
Yes, up to half
Yes, a modest contribution
Maybe, I'll have to check
No
Do you have other barriers to participating in this program that The Hearth should be aware of?
Do you have other questions or comments?
Email
This field is for validation purposes and should be left unchanged.
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