Apply for a scholarship

Mid America Dharma Scholarship Application

"*" indicates required fields

Please fully answer each question. The more information you provide, the better we can assess your need.

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Event you would like to attend:*

A minimum payment of 25% of the Actual Cost fee level is requested from all applicants. If you can pay more, please do so.

Amount you will pay:*

Can you provide service?*

Yes

What type of service can you provide?

Please describe your financial situation and reasons for applying for aid.*

Have you ever received a scholarship from Mid America Dharma in the past? If so, how recently?*

Do you identify as a person of color?*

Yes

Please specify your age range:*

18-30

31-45

46-60

61 or over

Do you suffer from any serious health conditions that contribute to your scholarship request? Please briefly indicate the condition.*

How long have you been practicing Insight Meditation? Briefly describe your current practice.*

Is there any other information you would like the committee to know?