Partial Scholarship Request

Woman Within Western USA presents programs that are life-changing experiences for many. Our hope is that no woman be excluded from this opportunity due solely to financial constraints.

Please contact us at scholarships@womanwithinwesternusa.org with any questions you might have.

Thank you,

The Scholarship Committee
Woman Within Western USA

Scholarship Application

Name*
First Last
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Event*
The events we are currently offering scholarships for are:
- Woman Within Circle Training
- Woman Within Weekend
- Skills Workshop
Woman Within Weekend Choice*
Woman Within Circle Training*
Woman Within Skills Workshop*
Why do you want to participate in this Woman Within program and what financial circumstances prevent you from doing so?*
Why do you want to participate in this Woman Within program and what financial circumstances prevent you from doing so?
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MONTHLY INCOME
Salary after taxes
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CS
Child Support
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(SSI)
Government support (SSI)
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SFA
School financial aid
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OFA
Other financial aid
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Total monthly income
Total monthly income
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MONTHLY EXPENSES
Housing
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CAR LOAN
Car loan
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CAR INS
Car insurance
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GAS
Gasoline
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FOOD
Food
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UTIL
Utilities (phone, internet, electricity, gas, water, etc.)
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HEALTH INS
Health care
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OTHER
Other monthly expenses (credit card, student loan, etc.)
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TOTAL EXP
Total Monthly Expesnses
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By checking the box below I am confirming the information provided on this form is true and correct. I agree to abide by all Woman Within Western USA policies and procedures if approved.*
By checking the box below I am confirming the information provided on this form is true and correct. I agree to abide by all Woman Within Western USA policies and procedures if approved.
Confirming this information is accurate.
Comments
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Partial Scholarship Request

Scholarship Application

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