TRAUMA 2 TREASURE APPLICATION FORM

TRAUMA 2 TREASURE VOLUNTEER PARTICIPANT APPLICATION
Welcome to Little Wave Coaching, I'm Sophie, and I'm so glad you'd like to volunteer as a Trauma 2 Treasure program participant! 😊

Please tell me about you and the specific memory you would like to help release through somatic work. What you share will help inform our consult as well as how to best structure your somatic trauma recovery session to enhance your experience. Also feel free to add in any questions or concerns that you may have. More may come up later as we chat and that's ok too.

Please bear in mind that there are many applicants to volunteer for this free program and that you may not hear back if you are not selected. Those who are selected for an intake call will receive an email within 5 business days after our call to find out if they have been selected as a current participant, or if they'd like to be placed on the waitlist (when all immediately available slots have been filled).

To enhance your chances of being selected, answer each question as thoroughly as you can, and describe the specific memory you would like to work on.

YOUR FREE RECORDED SESSION WILL LAST 2-3 HOURS, INCLUDING YOUR POST-INTERVIEW. PORTIONS OF IT MAY BE POSTED ON MY YOUTUBE CHANNEL OR WEBSITE TO INSPIRE OTHERS ON THEIR SELF-HEALING JOURNEY, GIVE THEM HOPE, AS WELL AS TO BRING AWARENESS TO THE INCREDIBLE POWER OF SOMATIC MODALITIES.

PARTICIPANT INFORMED CONSENT & SCOPE OF PRACTICE DISCLAIMER:

Coaches (including Certified Coaches like myself) are not licensed clinicians. I do not diagnose, prescribe, prevent, treat, or cure conditions of any kind, nor do I present myself as such. I do not provide crisis work, such as working with clients who are significantly and actively self-harming, currently chemically addicted, suffering from suicidal ideation, or are suicidal. Your safety is my priority, so if this describes you, please seek the care of a mental health clinician and/or access free Crisis Help immediately at: https://www.littlewavecoaching.com/getting-crisis-help

Always consult with your licenced clinician/doctor prior to starting any hypnosis program or somatic work of any kind, as it may interfere with some of your medications or health conditions. Only your trusted licensed healthcare professional can advise you as to what is right for your body or specific medical and/or mental health history and conditions. Please sign below prior to filling out your volunteer participant application form if you fully understand and agree to all these terms.

VIDEO/PHOTOGRAPH/AUDIO/MEDIA RELEASE AUTHORIZATION:

"I hereby irrevocably grant permission to Little Wave Coaching, LLC, and Sophie Gourdon, the right to obtain and publish filmed or audio recordings of me, such as portions of my recorded session, interview, etc., for the purposes of educating, informing, researching, or promoting somatic work. This grant includes the right to capture, record, obtain, publish, and use such images or other media in publications and promotional materials, such as Little Wave Coaching website or YouTube channel."

"I have read all of the above and fully understand and agree with its contents. I consent to the use of my recorded interviews, sessions, videos, photographs, and/or audio files as described above and without reservations."

Please sign below to indicate that you understand and agree with all of the above:
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Application Form (20 minutes)
1. What is your preferred name?*
2. What is your gender?*
3. What is your date of birth?*
4. How did you find me? (Friend/family/provider referral, Google or other engine keyword search, etc.)*
5. Which country or US city/state are you located in?*
6. Please tell me a bit about you (e.g. What is your relationship status? Do you have children? How old are they? Do you have pets? What is your occupation? What are your hobbies, interests, goals, or dreams? What matters most to you?)*
7. Are you a religious or spiritual person? Describe your faith, affiliations, practices, or belief system, if that's something that matters to you. If you've experienced religious or spiritual trauma, feel free to share here as well, as desired.*
8. Which modalities or somatic work are you curious exploring, if any in particular (e.g. Emotional Freedom Techniques/EFT/Tapping, Quantum EFT, Matrix Reimprinting, Beyond Quantum Healing, Hypnosis, Internal Family Systems/Somatic Parts work-informed coaching, Inner Child Work, Breath Work, etc.)?*
9. Have you or are you currently working with a coach or a therapist? If so, what kind and for how long? How is/how was your experience?*
10. What prompted you to apply for the Trauma 2 Treasure program as a volunteer participant?*
11. What are you most hoping to get out of your participation? What is your most pressing issue? ("The things causing me the most trouble or pain right now are...") Did you experience a recent shift with your chief concern and if so, what is the known or suspected trigger?*
12. Do you have a diagnosed (or suspected) physical health condition?*

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13. Do you have a diagnosed (or suspected) mental health condition?*

YesNo
14. If you have a diagnosed or suspected physical and/or mental health condition, you can list it/them here:*
15. Are you taking medications?*

YesNo
16. If you are taking medications, you can list them here:*
17. Do you suffer from suicidal ideation/thoughts?*

YesNo
18. Have you ever planned or attempted to physically hurt yourself, others, or to commit suicide?*
19. If you have questions or concerns about somatic/body-mind modalities, coaching, or trauma recovery, feel free to list them here. If nothing comes to mind at the moment, that's ok too, we'll have plenty of time together to explore! 😊*
20. What type of traumatic memory would you like to reprocess if you are selected (e.g. sexual, childhood, pre-verbal, medical, accident, religious trauma, etc.)? You do not need to share any details of your memory here (nor with me as there are ways to somatically reprocess traumatic content while protecting your privacy wherever needed). Your sense of felt safety is my priority.*
Emergency contact first and last name:*
Emergency contact relationship (friend, family, neighbor, etc.):*
Emergency contact cell phone number:*
Thank you for applying to become a Trauma 2 Treasure volunteer participant: Self-Healing is priceless, never give up on you!! 💗
I will not rescue you, for you are not powerless. I will not fix you, for you are not broken. I will not heal you, for I see you, in your wholeness. I will walk with you through the darkness, as you remember your light.

Sheree Bliss Tilsley~
Sophie Gourdon, Little Wave Coaching, LLC

M.Ed, M.A, CHt, CTRC, IFS-Informed Certified EFT®, Hypnosis & Trauma Recovery Coach™
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TRAUMA 2 TREASURE VOLUNTEER PARTICIPANT APPLICATION

Application Form (20 minutes)

Thank you for applying to become a Trauma 2 Treasure volunteer participant: Self-Healing is priceless, never give up on you!! 💗

Sophie Gourdon, Little Wave Coaching, LLC