Betty Alice Erickson & Kay Thompson Student Scholarship Fund Application

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Basic Contact Information

First Name

Last Name

Suffix

Title

Phone

Please indicate if you are a member of ASCH

I am enrolled in a FT Graduate Program.

I have completed at least one full semester/quarter of the program.

What training would these funds be applied to?

Faculty Advisory Information

First Name

Last Name

Phone

Essay

This application requires a short essay (maximum of 500 words) about the value of incorporating the use of hypnosis into your practice. You can cut and paste your essay from Word here:

Proof of Status

This application requires proof of status in the form of confirmation by a faculty member or supervisor on school, organization, or company letterhead that includes your eligibility. Please ensure all verification criteria is covered. Letters that are incomplete could disqualify you from consideration.

Click or drag a file to this area to upload.

Allowed file types: .doc, .docx, .pdf, .png, .gif, .jpg

Attestation and Acknowledgements

I understand that if I am awarded a scholarship, it will cover the registration fee for the Level 1 or Level 2.

I acknowledge that these funds do not cover travel or lodging.

I understand that funds awarded must be used or claimed within 12 months of the award date.

Signature

Please type name for signature

Date