Full Name*
Preferred Name (if different)
Email Address*
Phone Number*
Age*
Years of Service
City & State of Residence*
Branch of Service* ArmyNavyAir ForceMarinesCoast GuardSpace ForceNational GuardReserves
Why are you drawn to this work?*
What is calling you toward psychedelic healing at this point in your life?*
What do you hope to gain or shift?*
What healing, clarity, release, reconnection, or inner transformation are you seeking?*
What types of support or healing modalities have you tried?
VA servicesCounseling / TherapyEMDRSomatic therapy / Body-based workMindfulness / MeditationBreathworkSupport GroupsSpiritual practice / Faith-based supportPlant medicine / Psychedelic workOther
If you selected “Other”, please specify
Why does now feel like the right time?*
Do you currently have support in your life?* YesSomeNot Currently
If you’d like, share what support looks like for you
Is there anything you’d like us to know to help support you well if selected? (Accessibility needs, travel limitations, concerns, or anything that matters)
I confirm I am a U.S. veteran and the information provided is accurate.
I understand this is a scholarship drawing and submission does not guarantee selection.
I would like to receive occasional updates from Standing Tall Igniting Hope about future veteran healing opportunities and scholarships.
