Dance/Movement Therapy Application Form

1

Name

First Name

Last Name

2

When do you plan to start your courses?In the interest in cultivating community in the learning process, we create cohorts of students. Please indicate below when you would like to begin your study of dance/movement therapy.

3

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Phone Number

Please enter a valid phone number.

5

E-mail

example@example.com

6

Please share why you are interested in studying DMT.

7

Movement HistoryDescribe years of dance training and current movement practices. You may cut and paste a dance resume below.

8

Can you commit to a two year educational process to participate in a cohort of dance/movement therapy students?

Yes

No

Maybe

9

While some coursework through EEIC is offered online, in person attendance in Chicago, IL is required for coursework.Please note below any concerns or questions about in person attendance.

10

Clinical Counseling DegreePlease indicate your MA or MS degree, and/or Specify your current enrollment in masters level counseling, education or psychology training.

Professional Degree, Educational Insitution and Year of Graduation

Current Educational Institution and course of study

11

How did you find out about EEIC?

12

Upload transcript, degree or letter of acceptance in masters level clinical program

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

13

Please upload professional license (if available)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

14

Letter of RecommentationPlease upload a letter of recommendation from a professional contact or professor in your clinical training program.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

15

Please upload an image of yourself.Provide a JPG image that expresses who you are today. Maximum File size 10.8MB

Drag and drop files here

Select files to upload

16

Please provide a movement sample.Provide a video link (youtube, instagram link, vimeo or dropbox) that shares who you are through movement. Link can be private, but must be accessible for EEIC faculty to review. We encourage you to turn on your favorite music and improvise with full body movement for no longer than 1 minute. This is preferred over something that is previously choreographed.

17

Please upload a CV with any relevant work experience

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

18

Would you like to join the next advisement for prospective students?Advisement is offered once per quarter

YESNO