Application Form Name:* First Last E-mail:*Phone: Area Code - Phone Number FINANCIAL ABILTYAre you currently enrolled in another program?Full TimePart TimeNoProgram or institutionAre you presently employed?Employed full timeEmployed part timeUnemployedOccupationPlace of businessHow long employed?Monthly gross salary (before taxes) $Checking account average daily balance $Savings account average daily balance $Do you own your own home?YesNoValue of other assets $PERSONAL CIRCUMSTANCES1. Please describe any other details about your financial situation (such as dependents, unusual medical bills, etc.) that you would like us to consider when reviewing your application.*2. Please tell us the tuition amount that you are able to pay for this yearlong training (full tuition is $4400), in addition to room/board of $325/module.*3. If Gender Equity and Reconciliation International is unable to grant you the full amount of financial assistance requested, what other options are available to pay for the training?*4. Please list any skills, experience, services you have or can offer before, during, and after the training.SubmitResetBy submitting this application for Financial Assistance, I acknowledge that I have read and understand the points outlined in this document and attest that the information I have provided is accurate and true. Further, I understand all personal information provided will be kept confidential.
