Lomeli Fund Application Complete your application below. Lomeli Fund Application Full Name*(First, Last) Email*(Please use the email that would be used for the program) What is your combined annual household income?*Below $10k$10k - $50k$50k - $100k$100k - $150k$150k - $200kOver $200kAre you...*(Please check all that apply) Arab/Middle Eastern Asian/South Asian Black/African Indian White Hispanic/Latinx Non-White Hispanic/Latinx Native/Indigenous Pacific Islander White Biracial/Multiracial Prefer not to say 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?*One-time payment6 monthly paymentsWill 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?*YesNoIf 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) YesNoAnything else you would like us to know?* © Brenda Lomelli 2021 Privacy Policy terms & conditions terms & conditions