EMERALD VALLEY — PARTNERSHIP & COLLABORATION APPLICATION

EMERALD VALLEY — PARTNERSHIP & COLLABORATION APPLICATION
Thank you for your interest in collaborating with Emerald Valley.
We partner with individuals, organizations, educators, healers, clinicians, researchers, community groups, DEI leaders, nonprofits, retreat facilitators, spiritual practitioners, and aligned businesses who share our mission of equity, accessibility, trauma-informed care, cultural humility, disability inclusion, LGBTQ+ support, and community-centered healing in Oregon’s legal psilocybin ecosystem.

This form allows you to submit proposals for:

Educational partnerships
Research collaborations
DEI & cultural humility initiatives
Community healing or outreach projects
Retreat or workshop co-hosting
Psilocybin-related training opportunities
Referral partnerships
Organizational collaboration
Co-branded events
Something new you’d like to create with us
Our team will review your application and contact you if your proposal aligns with our upcoming needs and mission.
Non-Discrimination Statement
Emerald Valley does not discriminate on the basis of race, color, ethnicity, national origin, sex, gender, gender identity, gender expression, sexual orientation, marital status, age, disability, religion, creed, veteran status, socioeconomic status, family status, pregnancy, genetic information, citizenship status, or any other protected category under federal, state, or Oregon law. We provide an inclusive, accessible, and harassment-free environment for all collaborators and community partners.
SECTION 1 — Contact Information
Name

First NameLast Name
Pronouns
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization / Project / Business Name (if applicable)
Website or Social Links
SECTION 2 — Type of Partnership Or Collaboration You’re Seeking
Please Check All That Apply:

Educational partnershipResearch collaborationDEI, equity, inclusion, cultural humility partnershipCommunity healing programRetreat or event co-hostingWorkshop or training collaborationReferral partnershipOrganizational partnershipCultivation / mycology collaborationProfessional or clinical partnershipVolunteer or community support projectMedia / podcast / interviewSomething else (describe below)
If you selected “Something else,” please describe:
SECTION 3 — Proposal Overview
Please describe your collaboration proposal or idea in detail.Include goals, format, audience, and intended outcomes.
How does your proposed collaboration support Emerald Valley’s mission of equity, accessibility, trauma-informed care, and inclusive psychedelic education?
Who is the intended audience or community for this collaboration?
SECTION 4 — Experience & Background
Please share your background, experience, or organizational mission.
Do you/your organization have experience in any of the following? Psilocybin or plant medicine, somatic work, DEI / cultural humility, harm reduction, community healing, research, retreat facilitation, clinical or therapeutic work
Relevant credentials, training, or lived experience
Upload a CV, bio, brochure, or project overview (optional):

Cancelof
SECTION 5 — Collaboration Logistics
Preferred format for collaboration:

VirtualIn PersonHybridWorkshopPre-RecordedOpen to any formatOther
If selected 'Other' please describe
Proposed timeline, dates, or availability:
Is this a one-time offering or ongoing collaboration?
SECTION 6 — Accessibility & Inclusion
Do you or your organization require any accommodations to collaborate with us?
Are you interested in collaborating specifically to support marginalized communities (BIPOC, LGBTQ+, disabled, neurodivergent, low-income, rural, etc.)?

YesNoPossiblyTell me more
SECTION 7 — Additional Notes
Anything else you’d like us to know?
SECTION 8 — Agreement
I acknowledge that this form is an application for collaboration and that submitting it does not guarantee a partnership. Emerald Valley will review my proposal and contact me if aligned with current opportunities.

I agreeI do not agree
Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Should be Empty:

EMERALD VALLEY — PARTNERSHIP & COLLABORATION APPLICATION

Non-Discrimination Statement

SECTION 1 — Contact Information

SECTION 2 — Type of Partnership Or Collaboration You’re Seeking

SECTION 4 — Experience & Background

SECTION 5 — Collaboration Logistics

SECTION 6 — Accessibility & Inclusion

SECTION 7 — Additional Notes

SECTION 8 — Agreement