Scholarship Application

Thank you for your interest in this scholarship opportunity for one of my workshops. This opportunity was made with the intention of offering an active BWOC (birth worker of color) the opportunity to attend , who would otherwise not be able to attend .

I value being able to give back to the communities with the most birth outcomes disparities . Black, Indigenous and brown comunities. This helps sustain equity in our communities so that these practices may be severed to all and not just the privileged. It helps restore balance of the practices lost within our community .

This following questionnaire and application will help me make the very difficult task of choosing who can benefit from the most and who will be able to pay it forward the most.

With love and gratitude!

Tema

Name Name First Last
Phone Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Web Site
What workshop are you applying for ?
Will travel and lodging be an obstacle to your attendance?
What income range best describes your current household ( your income combine with your partners income , if applicabale)
If you are not selected but would still like to attend, what amount would you be able to pay?
Tell me about your role / roles as a birth worker? How long, training, certifications ect.
Tell me about your extra curricular activities, former or current volunteer work ect.
What current demographics are you serving?
What is your vision? What is your highest aspiration as a BWOC?
Anything else you would like to share with me?