Journey of Grace Retreat & FREE Scholarship Program Applications

Yearly Survivor Retreat Application

The "Journey of Grace" Human Trafficking Survivor Retreat is held several times a year for women 18 years of age and older who have been trafficked in the United States, been 'out of the life' for at least two years and who are not currently in any residential program for trafficking or addiction. The retreat is ideal for those who want to become not just survivors, but Thrivers and have already done hard work to heal. It is for those who need a little boost in their healing, who want to develop supportive relationships with other survivors and mentors and who are willing to work a little and love a lot.

The weekend is a combination of letting go, having fun and laughing, working hard on your inner self and working through triggers. There are massages, hair cuts and make overs, as well as classes on releasing your anger and forgiveness, nutrition, self defense and how to tell your story as well as group exercises on building trust. Each retreat is different and focuses on a different part of healing. The weekend is totally FREE but dependent upon our funding. If you aren't selected this time, we hope you will apply again. Space is limited. The location is in a safe place and everything is included. If you live far, we will also try to get you to the retreat for free as well. If you are accepted, please note that you will receive a group email along with the other survivors who will be attending. If you need your information to remain private, please let us know.

New 2019 & 2020: We are partnering with F.R.E.E., a program of the University of Toledo Human Trafficking and Social Justice Institute. They will be offering career assessment, an 8 week virtual readiness class, and scholarships. This funding is available if you want to take a class, get your license or certification in something, go to a technical or regular college, just about anything. If you are interested in financial funding for advancing your career, starting a new one this is your gateway to a new future.

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* 1. Applicant Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Do you identify with any of the following life experiences?

labor trafficking

sex trafficking

commercial sexual exploitation

survivor of other trauma

none of these

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* 3. What is your age?

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* 4. If flying to the retreat, what city would you fly out of? (if applicable)

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* 5. What is the highest level of school you have completed or the highest degree you have received?

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

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* 6. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 7. Would you like to apply for the F.R.E.E. Educational/Scholarship program?

Yes

Not sure

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* 8. Have you ever been incarcerated? (Note, this does not affect your application)

Yes

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* 9. Do you identify as LGBTQ?

Yes

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* 10. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 11. What would your dream job be?

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* 12. How much total combined money did all members of your HOUSEHOLD earn last year?

$0 to $9,999

$10,000 to $24,999

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

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* 13. Do you identify with any of the following religions? (Please select all that apply.)

Protestantism

Catholicism

Christianity

Judaism

Islam

Native American

Inter/Non-denominational

No religion

Other (please specify)

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* 14. In general, how would you rate your overall health?

Excellent

Very good

Good

Fair

Poor

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* 15. How long has it been since your most recent visit with your healthcare provider?

Less than 1 month

At least 1 month but less than 3 months

At least 3 months but less than 6 months

At least 6 months but less than 12 months

12 months or more

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* 16. Do you currently have health insurance, or not?

Yes, I do

No, I do not

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* 17. Do you currently smoke cigarettes, or not?

Yes, I do

No, I do not

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* 18. How many hours do you sleep each night?

4 or fewer hours

About 5-6 hours

About 7-8 hours

9 or more hours

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* 19. Do you have any dietary restrictions? If so what are they? (for retreat app)

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* 20. Do you have any allergies? If so, what?

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* 21. In general, how would you rate your overall mental or emotional health?

Excellent

Very good

Good

Fair

Poor

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* 22. Do you have any physical injuries or disabilities? If so, do you need assistance?

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* 23. Have you been in a recovery program? If so when and what type?

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* 24. What medications are you currently taking?

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* 25. Why do you want to attend the retreat? What do you hope to get out of it?

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* 26. Why do you want to apply for the FREE Scholarship Program? What do you hope to get out of it?

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* 27. Tell us about your story- being trafficked. Please tell us as much as you can so we can get to know you better. Not filling this out completely will eliminate your chances to attend the retreat. This will be the ONLY time you are asked to share this.

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* 28. Is there anything about attending a retreat that might be difficult for you to handle? Such as flying on an airplane or being in a hotel with other people, etc.

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* 1. Applicant Information

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* 2. Do you identify with any of the following life experiences?

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* 3. What is your age?

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* 4. If flying to the retreat, what city would you fly out of? (if applicable)

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* 5. What is the highest level of school you have completed or the highest degree you have received?

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* 6. Which of the following categories best describes your employment status?

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* 7. Would you like to apply for the F.R.E.E. Educational/Scholarship program?

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* 8. Have you ever been incarcerated? (Note, this does not affect your application)

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* 9. Do you identify as LGBTQ?

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* 10. What is your race or ethnicity?

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* 11. What would your dream job be?

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* 12. How much total combined money did all members of your HOUSEHOLD earn last year?

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* 13. Do you identify with any of the following religions? (Please select all that apply.)

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* 14. In general, how would you rate your overall health?

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* 15. How long has it been since your most recent visit with your healthcare provider?

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* 16. Do you currently have health insurance, or not?

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* 17. Do you currently smoke cigarettes, or not?

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* 18. How many hours do you sleep each night?

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* 19. Do you have any dietary restrictions? If so what are they? (for retreat app)

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* 20. Do you have any allergies? If so, what?

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* 21. In general, how would you rate your overall mental or emotional health?

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* 22. Do you have any physical injuries or disabilities? If so, do you need assistance?

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* 23. Have you been in a recovery program? If so when and what type?

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* 24. What medications are you currently taking?

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* 25. Why do you want to attend the retreat? What do you hope to get out of it?

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* 26. Why do you want to apply for the FREE Scholarship Program? What do you hope to get out of it?

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* 27. Tell us about your story- being trafficked. Please tell us as much as you can so we can get to know you better. Not filling this out completely will eliminate your chances to attend the retreat. This will be the ONLY time you are asked to share this.

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* 28. Is there anything about attending a retreat that might be difficult for you to handle? Such as flying on an airplane or being in a hotel with other people, etc.

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* 29. What are your triggers? (if you know) How do you handle them?

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* 30. Are you in counseling? If so, what type and how often?

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* 31. Who are your support people?

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* 32. Reference #1

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* 33. what is your relationship with them?

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* 34. Reference #2

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* 35. what is your relationship with them?

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* 36. What are your preferred pronouns