Scholarship Application

To start, how ready do you feel you are to make some major changes in your life and or your relationships?*
- 1 - Not Ready At All
- 2 - Somewhat Ready
- 3 - Definitely Ready
Glad to hear that! The Purify Your Gaze Program will be a life changing experience if you put in the work. Now, take a look at the list below, which of the following best describes you?*
- I am a student.
- I am employed full-time or part-time.
- I am self-employed.
- I am out of work or unemployed.
- I am a homemaker.
What's your gender?*
- Male
- Female
Which of the following best describes your age?*
- Under 21
- 21 to 29
- 30 to 39
- 40+
Where do you live?*
Country
While we commend you for taking this step for starting the Purify Your Gaze Program Scholarship application, we typically do not recommend our program as a starting step for individuals not ready yet to make major changes to their life or their relationships. Instead what we recommend is you start with our free anonymous assessment! After you complete the assessment you will receive a personalized report that will help you gain perspective on your sexual behaviors, where they fall on the continuum of sexual health, and recommended first steps to take.

Take The Quiz

You mentioned not being very familiar with Purify Your Gaze and our program so we thought to share with you a video tour of what the program offers so you are clear on what you are applying for and if this is right for you.

Having watched the overview video, are you still interested in continuing your Purify Your Gaze Scholarship Program application?*
- Yes
- No
We are sorry to hear that the Purify Your Gaze Program is not for you but on the flipside it may be for someone you know! Please do keep us in mind if you run into someone who needs help overcoming sexually addicted behaviors.

The Purify Your Gaze Program is delivered 100% virtually online and by phone. Regular participation requires your ability to have a reliable Internet connection and the ability to tune into weekly phone meetings. Do you have the technical capability to participate in the program?*
- Yes
- No
Thank you so much for taking the time to apply for the Purify Your Gaze scholarship. As you do not have the technical capability to regularly participate in the Purify Your Gaze Program we unfortunately do not believe our program is the right solution for you at this time. That said, this isn't goodbye and we want to still stay connected with you! Please continue to utilize our free resources directly from our website and social media sites and when you have the technical capability to regularly participate we are eager to have you in the program.

Why are you applying for financial assistance?*
Please list any extenuating circumstances that contribute to your financial need at this time (medical condition, disability, unemployment, etc.)
In 250-500 words answer why is receiving this scholarship important for you? What would receiving a scholarship to the program mean for you personally and for what you hope to do in your life?*
Please do not focus on your financial needs in this question. Rather, please tell us about what this scholarship means to you and what difference you hope to see by participating in our program.
What foreseeable complications or issues may prevent you from completing the program whether in terms of participation or following the recommendations given if you are awarded a Scholarship?*
Be as honest and thoughtful as possible in the section above. (Please note that any possible complications disclosed here will not necessarily disqualify you as a Scholarship candidate, but will help us customize your program)

What is the monthly amount (in $USD) you can commit towards your participation over the course of the 6 months?*
- $9.95/mo for 6 months and then continued at the same monthly rate.
- $19.95/mo for 6 months and then continued at the same monthly rate. (Suggested)
- $29.95/mo for 6 months and then continued at the same monthly rate.
- I cannot afford any of these levels.
What is the monthly amount (in $USD) you can commit towards your participation over the course of the 6 months?*
- $19.95/mo for 6 months and then continued at the same monthly rate.
- $29.95/mo for 6 months and then continued at the same monthly rate. (Suggested)
- $39.95/mo for 6 months and then continued at the same monthly rate.
- $49.95/mo for 6 months and then continued at the same monthly rate.
What is the monthly amount (in $USD) you can commit towards your participation over the course of the 6 months?*
Note: the minimum amount we permit is $5/month
Please enter a number greater than or equal to 5.

Program Goals