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Scholarship Application

* These fields are required

1 Welcome

2 People in your group

Guest 1		First name* Last name* Email* Phone (daytime)* I identify my gender as:* Your answer will support gender-based shared room assignment. If you identify as trans, non-binary, neutral, or otherwise genderqueer and are sharing a room, please select a gender that you are most comfortable sharing a room with. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.
Guest 1		First name* Last name* Email* Phone (daytime)* I identify my gender as:* Your answer will support gender-based shared room assignment. If you identify as trans, non-binary, neutral, or otherwise genderqueer and are sharing a room, please select a gender that you are most comfortable sharing a room with. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.

4 Tell us about yourself

Phone (daytime) *
Address line 1
Address line 2
City or region
State or province
Zip or postal code
Country *
I identify my gender as: *	Your answer will support gender-based shared room assignment. If you identify as trans, non-binary, neutral, or otherwise genderqueer and are sharing a room, please select a gender that you are most comfortable sharing a room with. Please contact us in advance of your arrival or call 1-800-822-4547 if you have any questions or concerns.

5 Your application details

Wisdom. Service. Community.
952 Bethany Tpke, Honesdale, PA 18431 USA
800 822 4547
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