Supervision Training: Enrolment Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

YesNo

Please state the cohort years (e.g. 2022, 2019..)*

YesNo

Please tell us a little more about your work. Tick the boxes and answer any questions relevant to you.*

Yes

YesNo

Please tell us a little more about your work. Tick the boxes and answer any questions relevant to you.*

Yes

Please follow the link below to book a 15 minute phone conversation with the course leader Shaura Hall

https://calendly.com/shaura-hall/consultation

YesNo

Please upload a copy of the document

Ethics*

Rows	Response
I am proactive in areas that cultivate equality for all beings.
It is important for me to do the inner work necessary to become self-aware.
I take responsibility for myself in relational interactions.
I am prepared to recognise and work it my innate biases, judgments and personal shadows.
I understand the importance of working with the support of supervisors, mentors and therapists.
I regularly explore myself through training and development.
I am committed to adhering to the professional codes of conduct stipulated by the Minded Institute and our accrediting bodies and work within our scope of practice, honouring our duty of care and ensuring the health, safety and well-being of those that we work with.
I understand that this course is accredited by the NCIP and those undertaking this training are expected to abide by the NCIP Code of Ethics available here: https://www.the-ncip.org/ethics

Code of Conduct*

Rows	Response
I am able to undertake a rigorous self-examination of their work and practice.
I honour the subjectivity of the training and supervision experience.
I respect commonly understood boundaries and conduct themselves at all times in accord with their professional status and in such a way that neither undermines public confidence in the process or profession of therapy/supervision nor brings it into disrepute.
I respect the position of all other medical/healthcare professionals and the boundaries of their professional remits.
I can demonstrate their ability to work with a wide variety of people, professional backgrounds, sexual orientation, culture, class, age, and relationship status as evidenced through active participation in teaching seminars, attention to transference and counter-transference phenomena as it arises within the group context.
I support the course through formal evaluation processes and, whenever required, draw attention to areas of personal or interpersonal conflict.
I agree not to undermine the course or faculty by making pejorative remarks.

Yes

Payment Option 1: £300 deposit followed by monthly installments of £400+Payment Option 2: £300 deposit followed by monthly installments of £300-399Payment Option 3: £300 deposit followed by monthly installments of £200-299Payment Option 4: £400 deposit followed by monthly installments of £150-199I would like to pay for the remainder of the balance in full once accepted onto the course.

Yes

Signature*

Date*

Date

Professional Supervision Training: A Somatic Approach

Ethical Approach and Code of Conduct

Course Payment

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