Women & Courage
Scholarship Application
Applicant Information
*
required fields
*
First Name:
*
Last Name:
*
Address:
*
City:
State/Province:
Zip/Postal Code:
*
Day Phone:
Evening Phone:
Cell Phone:
Fax:
*
Email:
Web Site:
Occupation
Employer:
Organization's Mission:
Income
Individual
*
Total Household Gross Annual Income as reported on most recent tax forms:
$
*
Total number of people in household (as shown on tax forms):
Organization (if applicable)
Total Organization budget:
$
Number of Employees:
Optional Information
Gender:
Female
Male
Age:
18-25
26-34
35-45
46-59
60-69
70 and over
Ethnicity:
American Indian/ Alaskan native
Hispanic/ Latino
Asian/ Pacific Islander
White/ Caucasian
Black/ African American
Multi - ethnic
Other:
Accomodations
*
required fields
I accept the accommodations available for this scholarship.
I do not need accommodations.
My preferred roomate is:
If children will be accompanying you and utilizing the Children's Program (ages 4-12 only), please list them below:
Name:
DoB:
Name:
DoB:
Name:
DoB:
Transportation
Omega runs a charter bus to and from Omega between New York City and the Rhinebeck campus on Fridays and Sundays. If awarded a scholarship, would you utilize this service? ($70 Roundtrip. Please see scholarship details to determine if cost is part of the scholarship.)
Yes
No
Special Needs
If you have any special needs, please specify them here
Course Selection
*
required fields
Please understand that submitting an application for a scholarship does not register you for the course.
Which Scholarship are you applying for?
Which course are you applying for?
Course #:
Faculty:
Dates:
Tuition Cost:
$
Materials Fee (if applicable):
$
Have you ever recieved an Omega scholarship?
Yes
No
If so, which workshop(s) or conference(s)?
Personal Short Answer Questions
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required fields
Please thoughtfully and concisely answer the following questions:
*
Why do you want to attend this program?
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How would you share or put to use what you learn at the event in your work, family, or larger community?