Bursary Application Form

Personal Information

First Name

Last Name

Street Address

City

Province

Postal Code

Phone Number

Email Address

Language

HT Level of Class

Current HT Level

Class Tuition

First day of class

Last day of class

Class Instructor Name

Class Location

instructor_email

I applied for a bursary this year

Yes No

Yes No

Financial circumstances

Healing Touch involvment

How the learned Healing Touch skills will be applied?

E-Payment (InterAc Email) Cheque

All the information provided is accurate, to the best of my knowledge.

Yes

I have read the Bursary Guidelines and agree with the terms and conditions of this pplication.

Yes

If the form is not sent after submitting, please make sure you have filled the form fully.