9 Month Facilitator Training Application

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

9 Month Facilitator Training Application Form
All information disclosed within this form is confidential and will not be shared with anyone outside of F.I.V.E.

Please do not leave any fields blank. If you can not fill out a field, simply write N/A. Be sure to fill in your name and email form fields, otherwise we will not be able to contact you.
Date

MonthDayYear
Date
How did you hear about the program?
If you chose "Other" - how did you hear about us?
What country do you currently reside?
Were you referred by anyone? If you have a referral code for a referral partner, please list it here:
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Location

CityCountry
Website/ Links

Website URLLinkden URL
Social Links

Instagram URLFacebook URL
Experiential Information

This section helps us understand your current personal relationship and understanding of 5-MeO-DMT.
When was your first experience with 5-MeO-DMT?
How many times have you sat with 5-MeO-DMT? (Full Doses)
How many times have you sat with 5-MeO-DMT (Low Doses)
How many different 5-MeO-DMT facilitators have you sat with?
Describe what is your personal relationship with 5-MeO-DMT like?
Why do you want to serve 5-MeO-DMT?
F.I.V.E. does not support work in countries where 5-MeO-DMT is illegal. Do you agree to serve only in countries where not illegal?

YesNo
Do you currently serve any other medicines?
Have you ever been a space holder or assistant for 5-MeO-DMT ceremonies that you have not personally sat in?
Please describe your mental health history. Have you ever been diagnosed, hospitalized or put on any medication?
Please list any credentials, trainings, or certifications that you have completed.
Have you ever been in a teaching or facilitating role?
How long have you spent with your own inner work before considering to step into a facilitation role?
Do you work with a therapist or specialist to support your growth?
What is your experience with other psychedelics and plant medicines?
What is your relationship like with self inquiry? How do you keep yourself accountable? What practices do you use? Do you have any teachers or mentors to support you in this? Please explain.
Have you ever taken a 5-MeO-DMT training course before? If so, please describe it.
We feel that the position of a facilitator means putting the participant first, please explain what this means to you.
Serving this medicine is a great responsibility and many facilitators loose sight of this, are you committed to continually growing, learning, and deepening your understanding of how to be of service to your participants?
Community References

Please list 3 references. A minimum of two references must be from a facilitator who has served you in the past, while the third can be a teacher, mentor or guide on your path. References will be contacted.
Facilitator #1 Name

First NameLast Name
Facilitator #1 Email
example@example.com
Facilitator #1 Phone Number
Please enter a valid phone number.
Please describe your relationship with this facilitator, how many times you have sat with them and what your experience with them was like.
Facilitator #2 Name

First NameLast Name
Facilitator #2 Email
example@example.com
Facilitator #2 Phone Number
Please enter a valid phone number.
Please describe your relationship with this facilitator, how many times you have sat with them and what your experience with them was like.
Reference # 3 Name (Teacher, Guide, Mentor, Facilitator..)

First NameLast Name
Reference #3 Email
example@example.com
Reference #3 Phone Number
Please enter a valid phone number.
Please describe your relationship with this reference, how many times you have sat with them and what your experience with them was like.
I certify that my answers are true and complete to the best of my knowledge. If this application leads to my acceptance in this program, I understand that false or misleading information in my application or interview may result in my release.

YesNo
Thank you for your submission to join F.I.V.E's 9 Month Facilitator Training!

Selected applicants will be contacted through email by F.I.V.E to continue the application process with a video interview.

The cohort begins in September. Applicants will be chosen no later than August 1st.
Should be Empty:

F.I.V.E.

5-MeO-DMT Information & Vital Education

Experiential Information

Community References