Community Connections Pods Application
Please allow our team about one week to review your application. We'll be in touch soon!
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
Please Select
Male
Female
Other
Do you prefer to meet with your pod in-person or by video/remote session?
Please Select
In-Person
Zoom / Remote Call
Either / No preference
Do you prefer to be in a pod that matches your gender, or are you open to a mixed gender group?
Please Select
Same Gender
Open to a Mixed Group
Please select the times of the week you are generally available to meet with your pod (you will meet with your pod to decide your specific time; this just helps us to form pods with similar schedules)
Monday through Friday: Mornings/Daytimes
Monday through Friday: Afternoons/Evenings
Saturday Daytimes
Sunday Daytimes
Is there anything important we should know about your schedule?
Can you briefly give a description of the healing experience you had that you’d like pod-support with integrating?
If the above experience took place in connection with a specific group, organization, or healer, can you please list their name here?
Why do you want to join a Community Connection Pod?
Is there anything else that would be helpful for us to know about your participation, or your needs for a specific kind of pod?
The cost to be part of the Community Connection Pods is $125. This fee goes towards training and ongoing pod support. Please select from the options below to indicate your capacity to contribute financially to this program.
Please Select
I can pay the cost in full
I require a partial scholarship to reduce the fee to $75
I require a full scholarship
I understand that I will be required to attend a 3-hour long training session to meet my pod and learn and practice the skills we will use for this program before we begin.
I agree.
I agree to make every effort to meet with my pod every other week for 75 minutes for three months. This basic commitment allows the group to deepen and support.
I agree.
I understand that pods are not intended to be a replacement for therapy. The emotional and relational support they provide may be powerful, but pod members will likely not have a therapist's skill or expertise.
I agree.
Submit
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