Submit Your Application To Be Chosen For Our Specialized Accelerated Fat Loss Program!
Lose Weight, Get TIGHT & TONED and RECLAIM YOUR BODY! ALL for FREE!
You Can Be Our Next Success Story!
Eligibility Requirements:
 Must be an A-State Faculty,Staff, Retiree, Spouse or Dependent.
All applications will be kept confidential & will only be viewed by our wellness coaches for the selection process. 

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* 1. Name

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* 2. Email

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* 3. Phone Number

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* 4. I'm an Arkansas State University

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* 5. Have you participated in any of our programs before?

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* 6. How much weight do you feel you need to lose?

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* 7. How has you current weight/shape been holding you back?

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* 8. How do you think you look in photographs?

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* 9. When you buy your summer bathing suit, do you buy one that flatters your assets or hides your problems?

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* 10. How does your family/spouse/significant other feel about your current shape?

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* 11. Why do you feel this time will be different than all the past times you tried to lose weight, but failed?

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* 12. How many times in the past have you tried to lose the weight?

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* 13. While there is no cost associated with this program, how much would it be worth to you, if you knew without a doubt in only 6 weeks from now you would be 20 pounds (or more) lighter?

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* 14. How will your life be better when you finally reach your fitness goals, have the body of your dreams and you are living a healthy and fit lifestyle?

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* 15. Once you have dropped 20 pounds in only 6 weeks and feel and look better than you ever have, do you plan on sharing your success story with your friends and family?

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* 16. Lastly, tell me why you think you should be chosen for this weight loss scholarship. Tell me your story, as much or as little as you would like.

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