Scholarship Application Form – INSTITUTE OF TRADITIONAL MEDICINE

Scholarship Application

ITM is committed to supporting individuals who have demonstrated a dedication to being of service to others, communities and the environment, but for financial reasons have difficulty in pursuing studies in their field of choice. For these reasons ITM offers partial scholarships to students who demonstrate a strong commitment to preserving these traditional medical systems and practices in order serve the community.

Dalia Mascarin Scholarship
In a very short time, Dalia Mascarin brought intense joy, love, hope and healing for the many who were blessed with knowing her. In honour of her life, and the happiness and healing that she brought to this world, ITM offers partial scholarships to individuals who have demonstrated a personal dedication to preserving the wisdom and practice of traditional medicine and healing, to serving families, and to bringing healing to this world.

Helen Harrison & St ella Black bird Memorial First Peoples Scholarship In honour of First Nations, and their commitment to sharing and protecting the teachings and medicine of this land, ITM offers partial scholarships to individuals who are of First Nations Descent, and who have demonstrated a personal dedication to preserving their traditional practices. Helen Harrison was a respected Quileute Elder and gifted healer from LaPush, WA. Stella Blackbird/Red Eagle Woman, from the Turtle Clan was an Elder, Healer and Medicine Teacher from Manitoba, respected for her ability to build trust and understanding across cultures and nations. We honour their love, memory, and tenacious efforts to keep the 'old ways' alive.

Please indicate the Scholarship you are applying for:

Dalia Mascarin
First Nations

Program Enrolment *

CEOLC
Herbal Medicine
Other

*If Other please state program

Name *

First

Last

Gender Identity *

Pronouns *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Living Status

Single
Married
Living in Parental House while Studying
Other

Number of Dependents *

Annual Household Income *

Are you currently employed? *

Monthly income from this position *

Do you anticipate receiving financial aid and/or any other additional funding for this program? If yes, please indicate the amount. *

How much financially can you currently afford to contribute to this training program/term? *

Personal Statement: Please provide any additional information in support of your Scholarship Application *

Declaration *

Agreed

By checking this box and submitting this application I acknowledge and agree to the following: Declaration: I hereby attest that all statements on this application form are true and complete in all respects, and no relevant information has been withheld. I agree and abide by the policies, rules and regulations of the Institute of Traditional Medicine including Scholarship policies. All scholarships and their particulars are granted, rescinded or subject to change at the discretion of the Directors of the Institute. Submitting this form does not guarantee the awarding of a scholarship. Determination of scholarship award is at the sole discretion of the ITM Advisory Board.