F.I.V.E Facilitator Vetting

F.I.V.E
5-MeO-DMT Information & Vital Education

Facilitator Vetting Form
All information disclosed within this form is confidential and will not be shared with anyone outside of F.I.V.E. and its panalists.

Please do not leave any fields blank. If you can not fill out a field, simply write N/A.
Date

MonthDayYear
Date
Facilitator Name

First NameLast Name
Facilitator Details

Facilitaton Company NameLocation of Service
Website Links

WebsiteSecondary Website
Social Links

FacebookInstagram
Number of years serving 5-MeO-DMT:
YesNo
Do you have any claims of malpractice or complaints within the community? If yes, please explain:
Have you ever been convicted of a sexual abuse? If yes, please explain:
Has anyone been physically or mentally harmed after sitting with you? If yes, please explain:
Do you serve other medicines alongside 5-MeO-DMT in your container? If so, please explain:
Please explain your dosage protocols when working with participants:
What safety measures do you have in place for participants?
What is your emergency protocol, if something adverse were to happen during ceremony?
Please describe your detailed protocols. What does first contact to last contact with a participant look like? Please be as detailed as possible.
What is your preparation protocol?
What is your integration protocol?
Do you serve with anyone? explain in detail. If you do serve with someone please list their name, phone number, email and number of years serving.
Do you have a mentor or multiple mentors in the community to ask support from or are you working solely on your own? If you don't have any mentors, please explain why not.
Training Information
123+
What was the duration of each of your training(s)?
What was the name(s) of your facilitator trainer(s)? Please include their social media, website and contact information.
Describe your 5-MeO-DMT Training. What did it include, was it groups, privates, one day or multi-day containers?
How many people did you serve during your training(s)?
Did you undertake any type of apprenticeship program? Please explain.
What additional trainings or credentials do you have that you use in your container with participants?
Community References

Please Include two references from facilitators within the 5-MeO-DMT community. Preferably one being the facilitator that trained you. References will be contacted.
Community Reference #1 Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to reference
Community Reference #2 Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to reference:
Participant References

Please Include two references of participants who have sat with you recently. References will be contacted.
Participant Reference #1 Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to reference:
Participant Reference #2

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to reference:
Facilitator Vetting Uploads

Please upload all information that gets sent to your participants.
Medical Screening Form

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Preparation Information

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Integration Information

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Photo of first aid certificate

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Photo of ceremonial space (if applicable)

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If there are any additional materials including materials that you had a difficulty uploading please send them here: info@five-meo.education

To complete your application submission:

-Please send your $350 application fee via paypal to: paypal.me/KaivalyaVenturesInc

Note: The above fee pays F.I.V.E. review panelists during the final step of the vetting process. If you do not have a paypal account, please email us and we will send you a personal invoice.

Once F.I.V.E has reveiwed your submission via your intake form and email including the above information, our team will be in contact with you to schedule your live video call with a panel to go over your process.

Thank you for your submission, we will be in touch shortly!
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F.I.V.E

5-MeO-DMT Information & Vital Education

Training Information

Community References

Participant References

Facilitator Vetting Uploads