Application - Oregon 2025 Psilocybin Training Program

Oregon Psilocybin Facilitator Training Course

Admissions Application
Acadia Professional Learning

admin@acadiaprofessional.com
(503) 963-7913
www.acadiaprofessional.com
Please Read Before Proceeding:

Requirements for enrollment in this course:
1. Must have a high school diploma or equivalent
2. Must be 21 years of age or older
Requirements for licensure in the State of Oregon:
1. The two requirements above
2. Ability to pass a criminial background check
Please note: You do not have to meet the state requirements for licensure to take this course, but you will NOT be able to apply for a license in Oregon if you do not meet ALL the listed requirements above.

Practicum Requirements

In order to successfully complete this program, you must complete your 40 hour practicum requirement IN PERSON either at an APL sponsored practicum or at a licensed service center with whom you have made arrangements for practicum. APL guarantees your ability to complete practicum through its practicum dates but cannot guarantee the availability or the cooperation of licensed service centers in Oregon for independent practicum placement.

If you cannot attend the APL Practicum dates, you have up to 1 year from your cohort start date to satisfy your practicum requirement by enrolling in and paying for practicum training with another service center or training program that has an established relationship with APL. APL makes no guarantees or assurances that those opportunites will be available, practical, affordable, or feasible. Therefore, you should plan to attend the APL practicum dates for your cohort in order to ensure your ability to successfully complete this course. You CANNOT complete the course without attending IN PERSON practicum either with your cohort or through another approved organization within 1 year of your program start date.
Spring 2025 Cohort Important Dates

1st day of class: Thursday, April 24th

All work submitted by: Thursday July 17th

APL Practicum: Thursday to Sunday, June 12th-15th in Portland, OR

Spring 2025 Class Times

Tuesday, Wednesday, and Thursday 5:00pm - 8:00pm on Zoom
Spring 2025 Tuition

Course with In-Person Practicum: $5900*

*This tuition assumes payment using ACH direct debit through Square payment processors. If a student elects to pay their tuition balance (after application and enrollment fees) with a credit/debit card, there is a 3% credit card transaction fee that is added to the total tuition ($177 total). If a student elects to pay using ACH debit, there are no fees.
Acknowledgements before beginning the application
I have read and understood the requirements for enrollment in this course*

Yes
I have read and understood the requirements for licensure in Oregon*

Yes
I have read and understood the practicum requirements*

Yes
I have read and understood the important dates for my cohort*

Yes
I understand that my $50 application fee is non-refundable*

Yes
I understand that if accepted and I choose to enroll in this program, I can pay my tuition balance using direct ACH payments through Square with no fees or pay using a credit/debit card with a 3% transaction fee applied*

Yes
Acadia Professional Learning does not discriminiate in administions on the basis of sex, age, race, color, ethnic orgins, or sexual orientation.
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Date of Birth*

MonthDayYear
Please upload a photo of a government issued ID that clearly shows your birthday*

Cancelof
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Have you ever applied to this program before?*

YesNo
Have you ever served in the US military?*

YesNo
Education Information
What level of secondary education have you completed?*

Did not complete high schoolGEDHigh school graduate
Check all that apply for your post-secondary education*

Have not attended college or universitySome college coursesCertificate or associates from community collegePrivate career school certificate/diplomaApprenticeship trainingBachelors degreeMasters degreeDoctorate or other terminal degreeOther
List the name of location of any post-secondary institution(s) you attended
Occupational Information
Are you currently employed?*

Yes, 35+ hours per weekYes, less than 35 hours per weekNo, not at this timeRetired
Please list any professional licenses or certifications you currently carry
Please use the official name and common abbreviation for your certificate/license
Interest and Expectations
Please describe your motivation and interest in pursuing the Psilocybin Facilitator Training Course. Include any personal or professional experiences that have influenced your interest in this field, including your level of experience with psilocybin mushrooms.*
Please describe your goals and expectations for completing the Psilocybin Facilitator Training Course. What do you hope to achieve or gain from this program?*
Information and Acknowledgements
I intend to apply for acceptance in the following program:

Psilocybin Facilitator Training Program by Acadia Professional Learning

All applications must submitted through this online form before the application deadline for any cohort. If you are having difficulty with your application, you can email admin@acadiaprofessional.com with questions.

Applications will not be considered complete until the $50, non-refundable application fee has been paid online below.
Spring 2025 Application Deadline

Tuesday, April 22nd, 2025

Spring 2025 Start Date

Thursday, April 24th, 2025
Acknowledgements and Signature
By signing below, I affirm that the information provided in this application is true, accurate, and complete to the best of my knowledge.

I understand that my application will not be considered complete until the $50, non-refundable application fee is paid.

I understand the requirements for admission into this program and also the requirements for licensure in the State of Oregon.

I understand that if I do not complete enrollment before the start date to which I am admitted, I may need to reapply for admission and pay the application fee again.
Signature

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Once you have submitted your application and paid the fee, we will process the information and let you now about acceptance within 3 business days.

Payment Section

Application FeeThis fee is non-refundable

$50.00 Quantity

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Oregon Psilocybin Facilitator Training Course

Acadia Professional Learning

Please Read Before Proceeding:

Spring 2025 Cohort Important Dates

Spring 2025 Class Times

Spring 2025 Tuition

Acknowledgements before beginning the application

Personal Information

Education Information

Occupational Information

Interest and Expectations

Information and Acknowledgements

I intend to apply for acceptance in the following program:

Psilocybin Facilitator Training Program by Acadia Professional Learning

Spring 2025 Application Deadline

Tuesday, April 22nd, 2025

Spring 2025 Start Date

Thursday, April 24th, 2025

Acknowledgements and Signature

Credit Card