Fill out this form completely to be considered for a 100% scholarship on the EBV Recovery Program.

NOTE: Those that are already in the EBV Recovery Program are NOT eligible to apply.

Full Name (First & Last) *
Email *
Phone
Where do you live (City & State) *

Are you applying for this scholarship based on financial need? *

If "other", please specify:

Tell us about your financial situation and home life. *

Tell us a little about what you have tried so far to try and improve your health. *

Which of our resources have you already consumed? *

Select all that apply.

What do you hope to gain from this course? *

How will EBV Recovery benefit your life and how do you plan to “pay-it forward” once you’re well? *

Are you able to commit to paying the $99 administrative processing fee? *

How did you hear about the EBV Recovery Program? *