This form is the first formal step toward enrolling in our training program. Please read every question in its entirety before answering. All answers will be kept confidential. We understand that it may make some people uncomfortable to put their experiences in writing. Please offer as much as you can. After reviewing your application, we will send you an e-mail to either invite you to an interview or let you know we do not feel our program is the right fit for you. After an interview, we will either let you know that we feel our program is not the right fit, offer you a position which can be secured with a $150 registration fee, or add you to a waitlist. You application is not complete until you pay the $25 application fee.

Synaptic Institute prohibits discrimination against its clients, employees, and applicants for employment and student applicants on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Synaptic Institute

For accreditation purposes we are required to collect the following data as described.

Please upload the following documents in pdf format.

We understand the significant cost of this and comparable programs and want to do everything we can to make it as accessible as possible to people of diverse socio-economic backgrounds. That is why we will be offering several tiers of scholarships in each cohort. Upon reviewing your entire application, we may offer a position in the cohort with or without a scholarship based on resources and the applicant's need. You will be required to apply for a scholarship through the Sheri Eckert Foundation, which, if granted you can use at any of the state accredited training programs. We will will also nominate qualified applicants for scholarships through the Healing Advocacy Fund. By answering "Yes" below, you are stating that you would not be able to enroll in the program without the the aid of a scholarship.

A non-refundable $25.00 application fee is required for your application to be processed.