Eat Breathe Thrive Professional Training Application Form

Eat Breathe Thrive Training Application

Thank you for your interest in the Eat Breathe Thrive Professional Training.

Applicants are considered based on professional training and experience, facilitation skills, community involvement, and leadership abilities.

To be considered for admission, you must:
- Complete the Eat Breathe Thrive Immersion.
- Be a helping professional, including:
  - Therapists, counselors, and mental health professionals
  - Registered dietitians and nutrition professionals
  - Yoga therapists and trauma-informed yoga teachers
  - Peer support workers, recovery coaches, and community health facilitators
  - Clinicians working in outpatient, day treatment, or community treatment environments
  - Teachers, school counselors, and staff in universities and colleges
If you have any questions about your eligibility for the training, please review our Frequently Asked Questions.
Admission Criteria
About You

Personal Information
Your Name:

First NameLast Name
E-mail:
example@example.com
Phone Number
Format: (000) 000-0000.
Date of birth:

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please upload a professional headshot:

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Co-Facilitation
Should you choose to co-facilitate, your application will be considered in conjunction with your co-facilitator's. Do you wish to add a co-facilitator?
Co-Facilitator's Name:

First NameLast Name
Co-Facilitator's Email:
example@example.com
Accessibility & Demographic Information

The following optional section informs efforts to ensure our courses and trainings are accessible to everyone. Any information you share will be handled in line with our Privacy Policy, and any identifying information will be removed before use. Your answers will remain confidential and will not affect the outcome of your application.
Age:
Ethnicity:

Other:
Please specify your sex / gender identity:

Other:
Please specify your sexual orientation:

Other:
What is your household income? (Please answer in the most appropriate currency)
Certification Pathway

For more information on the certification pathway, please visit this page.
Please select the certification path you are applying for:
Will you need a scholarship for this training?
If you have not yet applied for a scholarship, please apply for one via this form before submitting your application.
Skills and Experience

Eat Breathe Thrive Participation
Have you previously taken an Eat Breathe Thrive course, training, or seminar?
Which of the following have you participated in? Please check all that apply.
When did you take the Eat Breathe Thrive Immersion?
Don't worry if you can't remember the exact dates! Just the month and year will suffice.
Your Professional Experience
Do you work in any of the following professional fields?
Mental Healthcare
Medical Healthcare
Complementary Healthcare
Education
For how long have you been working in mental healthcare?
In which mental healthcare profession(s) are you qualified?
e.g. Psychologist, Psychiatrist, Therapist, Social worker, Counselor
For how long have you been working in medical healthcare?
In which medical healthcare profession(s) are you qualified?
e.g. Doctor, Nurse, Nutritionist, Dietitian, Occupational therapist, Physical therapist
For how long have you been working in complementary healthcare?
In which complementary healthcare profession(s) are you qualified?
e.g. Yoga teacher, Massage therapist, Chiropractor, Acupuncturist, Naturopathic doctor, Life coach
For how long have you been working in education?
Please list any certifications, licenses, or continuing education relevant to your implementation of Eat Breathe Thrive Interventions.
e.g., clinical licensure, yoga therapy credentials, trauma-informed training
Describe your experience facilitating groups or workshops, including settings (clinical, community, etc.) and populations served.
Describe your direct experience supporting clients with eating disorders or disordered eating, including therapeutic approaches or frameworks used.
Do you have formal training or experience in suicide prevention or crisis intervention? If yes, please summarize your background (e.g., certifications, protocols, clinical contexts).
Your Skills
Consider the following skills and rate yourself on a scale of 1-5, where 1 is poor, and 5 is excellent:
Active Listening Skills

1

2

3

4

5

1 is Poor, 5 is Excellent
Setting Professional Boundaries

1

2

3

4

5

1 is Poor, 5 is Excellent
Offering Empathy and Care

1

2

3

4

5

1 is Poor, 5 is Excellent
Building Trust and Rapport

1

2

3

4

5

1 is Poor, 5 is Excellent
Self-Care after Difficult Professional Experiences

1

2

3

4

5

1 is Poor, 5 is Excellent
Managing Transference and Countertransference

1

2

3

4

5

1 is Poor, 5 is Excellent
Asking for Help from Supervisors and Mentors

1

2

3

4

5

1 is Poor, 5 is Excellent
Proficiency with Zoom and Online Facilitation

1

2

3

4

5

1 is Poor, 5 is Excellent
Time Management Skills

1

2

3

4

5

1 is Poor, 5 is Excellent
Communication Skills

1

2

3

4

5

1 is Poor, 5 is Excellent
Confidence in Public Speaking

1

2

3

4

5

1 is Poor, 5 is Excellent
Problem-Solving Skills

1

2

3

4

5

1 is Poor, 5 is Excellent
Marketing Skills

1

2

3

4

5

1 is Poor, 5 is Excellent
Supporting Documents
Please upload your resume.

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Please upload a current copy of your professional insurance.

Note: your policy must be current for at least the next six months
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Your Lived Experience
We welcome applications from professionals with lived experience of eating disorders. For the wellbeing of facilitators and participants, we ask that applicants have at least two years of sustained recovery before undertaking this training.
Please indicate your current readiness to undertake this training:
Is there anything you would like to share about your lived experience with eating disorders, disordered eating, or mental health challenges?
Have you been diagnosed with an eating disorder in the past five years
Please describe the self-care routines and professional networks you have in place to support your wellbeing in this work (e.g. therapy, mindfulness, supervision, mentorship, peer consultation).
Strengths and Growing Edges
Why are you interested in learning to lead the Eat Breathe Thrive intervention(s)?
How will this training support you in your professional work?
What do you consider to be one of the greatest strengths you bring to this work?
What do you anticipate might challenge you in particular about facilitating the Eat Breathe Thrive intervention(s)? How will you overcome those challenges?
What is do you foresee will be your greatest challenge in this training?
Why do you think you would be an effective facilitator of these interventions?
Community and Outreach
In which city do you intend to offer the Eat Breathe Thrive course?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
On average, how many clients or students do you work with per week?
For each of the following social media channels, please indicate those upon which you are active, and the nature/purpose of your account:
Facebook
Twitter
Instagram
LinkedIn
Pinterest
Please include URLs to any personal and/or professional social media pages below:
Do you have a website or mailing list you use to communicate with clients and students?
Professional website or mailing list
Personal website or mailing list
This training will prepare you to lead group interventions for eating disorder prevention and recovery. How many participants do you expect you would be able to recruit for your first group if you were to move forward with the training?
Please use this space to share any additional comments or questions you may have:
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Eat Breathe Thrive Training Application

About You

Personal Information

Co-Facilitation

Accessibility & Demographic Information

Certification Pathway

Skills and Experience

Eat Breathe Thrive Participation

Your Professional Experience

Your Skills

Supporting Documents

Your Lived Experience

Strengths and Growing Edges

Community and Outreach