Application for Sacred Immersion Training™

1

Name* This field is required.Please enter your name.

First Name

Last Name

2

PronounsPlease let us know your preferred pronouns.

3

Email* This field is required.Please enter your email address.

example@example.com

4

Address* This field is required.Please enter your current address.

Street Address

Street Address Line 2

City

State

Zip Code

Country

5

Your Phone Number* This field is required.Please enter the best phone number for you.

Area Code

Phone Number

6

Birth Date* This field is required.

Birth Date

7

Degree(s) Earned* This field is required.

Energy Healing Practitioner

Licensed Massage Therapist

PhD or PsyD in Counseling, Psychology, Social Work, etc.

Master of Social Work

Master of Counseling

Medical Doctor (MD or DO)

Physician Assistant

Nurse Practitioner

Other

8

If you answered "other" to the previous question, please list below.If you answered with one of the degrees, please continue on.

9

Years of Experience in healing/therapeutic/medical/service work?

Less than 5 years

5 to 10 years

10+ years

10

As a potential student, please share a bit about yourself guided by the following questions.

The purpose of this application is to get to know you, to help you clarify your intentions for participating in the training, to provide us with a brief background about your work and personal experiences, and to determine if you are a good fit for this training. This form is encrypted.

Please plan on your writing taking a total of between 30 - 60 minutes.

11

What do you find challenging about your work?

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What do you find rewarding about your work?

13

What personal growth work have you engaged in in the past and currently?

14

If you have experienced any personal trauma, how have you worked through it?

15

Do you incorporate any trauma-informed practices in your work? If yes, please describe.

16

Please give an example of how you have worked with a difficult client recently.

17

If you have ever had a psychedelic experience, why and what did you learn?

18

Why do you desire to participate in this training?

19

SignatureBy signing below, I agree that all I have stated is true.

20

Date* This field is required.

Date

21

Application FeeWe are honored to have you apply for our program! Please select the "Application Fee for SIT Program below and follow the prompts below to pay the administrative application fee.

My Bag

1

Application Fee for SIT ProgramThis is a one-time payment fee for administrative purposes.
$18.00Edit
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Payment Methods

Credit Card

First Name

Last Name

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Apple Pay

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