Reclaiming Self - Scholarship Interest Consideration

Reclaiming Self: A 3-Day Restorative Experience for Grief + Cancer Survivors
You survived the diagnosis. You made it through the loss.
But no one prepared you for the after.

This experience uses somatic tools and trauma-aware practices to help you feel safe, steady, and begin reclaiming the emotional resources.

Before We Begin:
To support a safe and steady space for everyone, each participant will need to complete a short intake form and sign a participation agreement.

These aren’t just formalities, they help me understand your needs and ensure this experience stays emotionally regulated and well-held.

Please complete both as soon as possible after registration. Your spot isn’t fully confirmed until they’re submitted.

Phone *

Address

Street Address

City

State

Country

Postal code

Other- Not listed Above: What type of loss have you experienced?

What prompted you to seek support at this time? *

Have you engaged in any grief support or counseling previously? If so, what was your experience like?

Other- Not listed Above: What specific challenges or emotions are you currently experiencing?

How do you envision your life after beginning to process your grief?

If you feel comfortable, tell me a little about yourself in 1–2 sentences.

If yes, please specify:

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

I understand that scholarships are limited and offered based on need and fit. I ask for support in good faith. *

I agree

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