Name *

First Name

Last Name

Age & Eligibility *

The two below checkboxes outline eligibility for submission; please read carefully and select both boxes to be considered for this scholarship.

I certify that I am [or will be] 21 years of age or older by April 6th, 2024

I identify as a woman

Travel Coverage & Eligibility *

This retreat takes place April 6th-13, 2024 in Riviera Maya, Mexico. Please note that in order to qualify, you must: 1. Be available for the full inclusion of dates April 6th-13th, 2024 (no partial stays). 2. Have a valid passport not expiring within 6 months of travel dates / be a U.S. citizen OR have dual citizenship between the U.S. and Mexico. If the latter applies to you, you must have a valid ID in order to travel. The two below checkboxes outline travel eligibility for submission; please read carefully and select both boxes to be considered for this scholarship.

I certify that I am available for travel April 6th-13th.

I certify that I have a valid passport that does not expire within 6 months of travel dates OR I have citizenship in Mexico OR I have dual citizenship within my current permanent residence & Mexico + a valid ID for travels.

Sponsorship Coverage & Additional Incurred Costs *

Should you be awarded the participant sponsorship, it includes coverages for accommodations, food, and activities from April 6th-13th. For more information on included activities, please scroll to the top of this page, visit the top navigation > Wellness Retreats > April 2024 Retreat

I understand that, should I be awarded this sponsorship, that it covers my accommodations, food, activities, and transportation from Cancun International Airport to the retreat location [and back upon departure].

I understand that, additional expenses including but not limited to purchases made on site or during my travel to the retreat, additional activities not listed on the retreat page are NOT included as part of my participant sponsorship, and that any additional costs incurred are a personal responsibility.

I understand that additional costs incurred may include (but are not limited to): gifts, souvenirs, meals/snacks outside of the retreat location, massage, alcoholic beverages, travel to my nearest airport, or other personally elected purchases.

Privacy Statement & Non-Discrimination Clause *

We are committed to fostering an inclusive and diverse environment. In line with our non-discrimination policy, providing information in this section is entirely optional and will be used exclusively to ensure equal opportunity and representation in our program. Your decision to disclose any information here is completely at your discretion, and you are welcome to share as much or as little as you feel comfortable with. Please rest assured that any details provided will be treated with the utmost confidentiality and respect.

I certify that I have read through the privacy statement included below

I certify that I have read through the non-discrimination clause below

Rooming with others *

Should additional funding become available for a second recipient, are you comfortable sharing a room and queen bed with another female?

Yes, I am comfortable sharing a room & bed

Yes, but only if it's with the person who nominated me or a friend of mine who's attending (please make note of this in your personal statement)

No, I am not comfortable sharing a room & bed

Compassion Statement *

This retreat is designed to not only support you on a personal level, but cultivate a community of individuals and a supportive, welcoming environment. By signing up, you agree to treat both yourself + your fellow attendees with kindness, compassion, & an open mind. This is a space to come as you are, regardless of your gender, race, sexual orientation or religion, and any form of discrimination or bullying will not be tolerated. Please know that joining the retreat means stepping into a safe space where you are free to explore, love & nourish you just as you are.

Yes, I agree

No, sorry, I cannot make it

Applicant Acknowledgement & Agreement *

By submitting this form, I affirm that all information I have provided is true and accurate to the best of my knowledge. I confirm that I have thoroughly read, understood, and agree to abide by the rules, regulations, and selection process for the Get Rooted: Wellness Retreat. Additionally, I agree to the following terms: I acknowledge that this application does not guarantee my participation in the retreat and that selection decisions are final. I understand that the sponsorship is specific to the Get Rooted: Wellness Retreat for the designated dates and location, is non-transferable, and cannot be exchanged for any monetary value or other compensation. I agree to respect and adhere to all retreat guidelines and policies, including any health and safety protocols in place. I consent to the use of any feedback, testimonials, or images obtained during the retreat for promotional purposes, in line with the organization’s privacy and usage policies. I understand that any false information or misrepresentation may result in disqualification from the selection process or revocation of the sponsorship. This agreement reflects my commitment to the integrity of the application process and my understanding of the conditions associated with the Get Rooted: Wellness Retreat sponsorship.

Yes, I agree