Revision as of 15:53, 21 June 2016

Applicant

Name:
Date of birth:	-	Country of origin:

Email:
Telephone:

About the Scholarship:

Program attended:
From to .

Previously completed programs:

@@ Line 55: / Line 55: @@
 |}
+=Center=
+===Retreat Center Affiliations===
+{| class="appli-form-table"
+|-
+! Retreat Center Name:
+| [[center::{{{center|}}}]]
+|-
+! Street
+| [[centerstreet::{{{centerstreet|}}}]]
+|-
+! City
+| [[centercity::{{{centercity|}}}]]
+|-
+! State or Province:
+| [[centerstateprov::{{{centerstateprov|}}}]]
+|-
+! Postal Code:
+| [[centerpostalcode::{{{centerpostalcode|}}}]]
+|-
+! Country:
+| [[centercountry::{{{centercountry|}}}]]
+|-
+! Application is for:
+| [[retreattype::{{{retreattype|}}}]]
+|-
+! Retreat starting date:
+| [[startdate::{{{startdate|}}}]]
+|-
+! Retreat end date:
+| [[enddate::{{{enddate|}}}]]
+|-
+! Retreat master:
+| [[retreatmaster::{{{retreatmaster|}}}]]
+|-
+! Retreat administrator:
+| [[retreatadministrator::{{{retreatadministrator|}}}]]
+|-
+! Administrator email:
+| [[retreatadministratoremail::{{{retreatadministratoremail|}}}]]
+|-
+! Retreatant liason person:
+| [[retreatliaison::{{{retreatliaison|}}}]]
+|-
+! Liaison email:
+| [[retreatliaisonemail::{{{retreatliaisonemail|}}}]]
+|}