Full Name *

Phone *

Email *

City & State *

Number of children and their age *

Are you currently a SAHM *

Yes

Current household income range *

What would this Scholarship mean to you *

150 words or less

How long have you been experiencing hip pain *

Rate your current pain level (1-10) *

How is hip pain affecting your daily life *

Describe your struggles in 150 words or less

Explain 'Other'

What are you hoping to achieve *

150 words or less

Are you committed to completing the full 8-week *

Yes, absolutely

Yes, but I have concerns

Not sure

Can you dedicate 1-2 hours per week for 8-weeks *

Are you ready to implement the strategies taught *

Agreement *

I understand this is a scholarship with limited spots

I commit to my selected payment plan if accepted

I understand all sales are final with no refund

I will not share program content with others

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