Lomeli Fund Application - Brenda Lomeli

Full Name*

(First, Last)

Email*

(Please use the email that would be used for the program)

What is your combined annual household income?*

Are you...*

(Please check all that apply)

What would you like to accomplish in The Last 10 Program (Please be specific)*

What have you done already to work toward this goal or goals?*

How would this allow you to change your life?*

What size of grant are you requesting?*

*This should be the minimum amount to make your participation in the program possible. The total program investment is a single payment of $3,894 or 6 monthly payments of $699. Grant amounts range from $500 - $1,947.

How would payments need to be structured for you to be able to contribute the remaining amount?*

Will you be able to participate in the program if you do not receive a grant? What would you need to do to make that possible?*

If accepted, are you FULLY committed to making a financial, emotional, and time commitment inside The Last 10 Program?*

If you receive a scholarship, you will be expected to have fully participate in The Last 10 Program.*

Including: attend at least one coaching call each week, ask for coaching at least once per week and complete The Last 10 curriculum (* the basic program requirements are as stated in your client agreement)

Anything else you would like us to know?*