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PLUMLINE APPLICATION

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I'm Interested In...*
What do you hope to get out of Plumline? (Select all that apply)*
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Other:*
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Have you done counseling or therapy previously?*
Have you considered or attempted harming yourself in the past 12 months?*
Do you have any questions or concerns about group work?
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Apply to Plumline

First Name
Last Name
Email*
Phone*
I'm Interested In...*
What do you hope to get out of Plumline? (Select all that apply)*
- Healthier Relationships
- More Peace
- Life Clarity
- Heart Healing
- Increased Meaning
- Get Unstuck
- Other
Other:*
What day(s) work best for you to attend your Plumline experience?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Any of these days
What time of day works best for you to attend your Plumline experience?*
- Morning
- Lunchtime
- Afternoon
- Evening
- Any of these times
Have you done counseling or therapy previously?*
Have you considered or attempted harming yourself in the past 12 months?*
Do you have any questions or concerns about group work?
Name
This field is for validation purposes and should be left unchanged.

Plumline Scholarship

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Last Name
Email*
Phone*
Have you received scholarship support from Plumline previously?*
What is your yearly household income?*
How much of the group cost are you able to contribute?*
Click below to submit your application and schedule your interview.

Plumline Application

First Name
Last Name
Email*
Phone*
I'm Interested In...*
What do you hope to get out of Plumline? (Select all that apply)*
- Healthier Relationships
- More Peace
- Life Clarity
- Heart Healing
- Increased Meaning
- Get Unstuck
- Other
Other:*
What day(s) work best for you to attend your Plumline experience?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Any of these days
What time of day works best for you to attend your Plumline experience?*
- Morning
- Lunchtime
- Afternoon
- Evening
- Any of these times
Have you done counseling or therapy previously?*
Have you considered or attempted harming yourself in the past 12 months?*
Do you have any questions or concerns about group work?
Phone
This field is for validation purposes and should be left unchanged.