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Breath and Sound scholarship form

Breath and Sound INC is happy to provide a free entry to our events for those in need. Note that the information you provide is confidential and will only be used to determine if you qualify for the scholarship. 

Full Name

Phone

Email

Are you experience any of these? (check one or more boxes)

Anxiety or depression

Financial difficulties

Difficulty abstaining from substances

Actively attending AA meeting

Recovering from severe intoxication

Grieving over the loss of a loved one

Seeking shelter, difficult living situation

None of these

Tell us more

I would like to attend

Thank you!

Please give us 24 hours to proceed your form. We will get back to you via email. Please add jenya@breathandsound.org to your email list.

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