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The Project Impact Retreat Scholarship Application

Name *
Name
Phone *
Phone
Are you currently a Student? *
If selected are you willing to become a program ambassador? (Program ambassadors may be ask to speak about the program by giving a testimonial or assist with marketing future programs) *
If awarded a partial scholarship you must be willing to purchase your ticket within 5 days of being rewarded or we will need to share the opportunity with someone else ready to take advantage of the scholarship. *
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