Weekend Program Scholarship Application

SCHOLARSHIP INFORMATION

Partial, need-based scholarships in the amount of $100 – $350 per applicant are available. In order to encourage a diverse student population we’re also offering need-based scholarships to People of Color, each awarding $1075, which pays 50% of the Weekend Program tuition. You may apply for one scholarship and indicate your choice below.

The Gestalt Therapy Institute of Los Angeles (GTILA) also offers scholarships to those in need who are training at PGI. For more information from the GTILA website, click here.

For more information about the Online Weekend Training Program and the availability of partial scholarships, please contact Stella Chesler:

Phone: (323) 418-2648
Email: pacificgestaltinstitute@gmail.com

Personal Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Fax

Current employer (include position held) and/or school attending:

If this is your 1st year of training with PGI, how did you hear about us?

Partial Scholarship Request

I am applying for:

Need-based scholarship

People of Color based scholarship

Amount Requested:

Reasons for Request (Please be specific):

Signature

Important information: If you are granted a partial scholarship for the Ongoing Weekend Training Program you may be required to help with some of the logistical arrangements needed throughout the year. These arrangements may include set up and tear down of the rooms for each weekend, bringing bagels prior to the Saturday and/or Sunday sessions, etc. You will be reimbursed by PGI for any approved purchases.

Trainee Signature:

Date

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Faculty

Armin Baier
L.C.S.W., J.D.

Ren Barnebey
M.F.T.

Christine Campbell
M.F.T., A.T.R.

Lynne Jacobs
Ph.D.

Michelle Seely
M.F.T.

Gary Yontef
Ph.D., A.B.P.P.

Pacific Gestalt Institute

1800 Fairburn Ave
Suite 103
Los Angeles, CA 90025
Tel: 323-418-2648