Financial Aid Application

Name:
Email Address:
Date:
Check off interests: One-on-One Coaching Sessions
Making Peace With Food Workshop
Personal Peace Workshop
Habit Breaking Workshop
Phobia Workshop
Personal goals & reasons
for seeking coaching
or attending a workshop:
Please indicate the fee(s)
you feel you can afford
for the applicable services:		 $ per one-on-one session
$ for a series of 7 workshops