Healing Together Programme - Accredited Facilitator Application Form

APPLICATION FORM
Please note the content of the training can be upsetting and triggering for delegates. Therefore, if you are currently going through any difficulties please consider whether the course is suitable for you at this moment in time. If you are unsure, please contact a member of our team to discuss further. healingtogether@innovatingmindscic.com
Personal Details
Full Name (Add first name and last name)*

First NameLast Name
Email Address (this is the email address we'll contact you at)*
Double check your email address is correct
Phone Number*
Job Title*
Early Years Setting Name*
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Readiness & Motivation

Please give further details below
What challenges do you anticipate with making trauma informed systemic changes within your early years settings?*
What support do you have to implement trauma informed systemic changes? (i.e. support from senior leaders, financial resources, protected time)*

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Declaration

Please confirm that you agree to the terms & conditions of this application
For the purpose of progressing with your application, we are required to process your personal data. This processing is carried out in accordance with Innovating Minds Terms & Conditions as below.

We require that you consent to this processing and to receive communications from us.

By submitting this application form, I confirm:
1. I have read the Terms & Conditions
2. I have Disclosure Barring Service (DBS) or other regulatory clearance to work with children and/or adults
3. I agree to adhere to the training etiquette.
4. That the information given in this application is true, complete and accurate
Terms & Conditions*

I agree to the above terms and consent to processing of my personal data
How did you hear about us?*
How did you find out about Healing Together?
Print Name*
Signature*

Clear
Date*

DayMonthYear
Date
Thank you for completing your application. We look forward to welcoming you to this unique trauma-based training.
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APPLICATION FORM

Personal Details

Readiness & Motivation

Declaration