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Learning Grant Form
Learning Grant Form
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" indicates required fields
Dear Friends,
We depend on the help of many people to keep our doors open to all. We are pleased to offer some support for your journey. We hope we will be able to make your participation possible. Our financial assistance program is administered by a small committee that tries to be equitable in distributing funds throughout our programs and to a range of individuals. It is helpful to the committee to have some information to use in the decision making process.
Therefore, we ask that you complete section A, B, C, and D. Due to high demand and to help us process your request immediately, please return this form as soon as possible, but no later than 7 days after receiving the form.
We limit these grants to one (1) per person in our fiscal year (07/01 to 06/30). Level of aid is determined by cost of retreat and agreement to our committee.
You will be responsible for paying any outstanding balance that is not covered by the amount of assistance offered to you. Payments plans are available. For more information about payment plans, please contact Cristina Esguerra at 650-340-4527 or mc@sistersofmercy.org.
Section A: Applicant Information and Request
Date
*
MM slash DD slash YYYY
Name
*
First
Last
Phone
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Retreat Name
Retreat Date
Retreat Fee
Section B: Program Category (Select one or all that applies)
Please apply at least 1-2 weeks prior to the start of your program.
Art & Practice of Spiritual Direction Flow:
Program grants are given to a limited number of participants who apply for each billing cycle. Maximum is $2,000 per year.
Sacred Journey:
Program grants are given to a limited number of participants who apply. Maximum is $500.
Spiritual Exercises:
Program grants are given to a limited number of participants who apply. Maximum is $500.
Summer at the Center:
Program grants are given to a limited number of participants who apply. Maximum is $500.
Retreat Scholarships:
Financial aid for our retreats is made possible by our donors.
Section C: Financial Situation
1. What is your present source of income? (i.e., job, disability, social security, etc.)
*
2. Do you have any other sources of support? (i.e., continuing education money from employer, faith community, etc.)
*
3. Are your monthly expenses over, under, or compatible with your income?
*
4. How much money do you feel capable of contributing toward this cost?
*
Section D: Request for Assistance
Please share with us your reasons for requesting financial assistance.
*
Special Thanks
We would like to give a special thanks to our donors and charitable foundations that support our Learning Grants: Sisters of Mercy of the Americas, The Gellert Foundation, The O'Shea Foundation, and Private Donors.
*
I certify that all of the above information is true and correct. I understand that this information will be kept strictly confidential and is only used in determining eligibility.