Silver Eye Institute Scholarship Application

Silver Eye Workshops Scholarship Application

Our goal is to make the Silver Eye Workshops as inclusive as possible. Use the form below to tell us a little but about yourself and your interest in our workshops and we will work to make them as accessible as possible. All questions are optional and all answers will be kept confidential.

Name*

First Name

Last Name

Email*

Which workshop would you like to enroll in?

What interests you about this workshop?

What is your age?

Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Which categories describe you?

American Indian or Alaska Native Asian Black or African American Hispanic, Latinx, or Spanish Origin Middle Eastern or North African Native Hawaiian or Other Pacific Islander White

Other:

What is your gender identity?

Female Male Non-Binary

Other:

Do you consider yourself as a member of the LGBTQIA community?

No Yes

Other:

What is the postal code of where you live?

Are you currently a student?

No Yes

Where are enrolled?

Assistance Needed

I would join this workshop with a 50% fee reduction I would join this workshop if the fee were waived

Other:

Are there accommodations we can make in order for this class to be more accessible for you?