Facilitator Certification Application

Facilitator Certification Application

Apply to join an upcoming facilitator certification cohort. Submission does not guarantee acceptance.
SECTION 1 — APPLICANT INFORMATION

Tell us about yourself.
Full Legal Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
City / State / Country*
Organization / Institution Name
Role / Title
Preferred Name / Pronouns
How did you hear about this certification?*
Which certification track are you applying for?*
Do you currently have an active group or context for implementation?*

Yes — active organization/groupDeveloping contextNot yet — seeking guidance
Briefly describe the group or setting where you plan to facilitate*
Why are you seeking facilitator certification at this time?*
SECTION 2 — PROFESSIONAL READINESS

Tell us about your facilitation experience and commitment.
Have you facilitated trainings or groups before?*

Yes — regularlySome experienceNo formal experience
If yes, briefly describe your facilitation experience
Can you commit to a full 3-month cohort?*

Yes — full commitmentI may need scheduling discussion
I agree to operate within facilitation standards and licensing expectations, including ethical conduct, licensing boundaries, and participant safety.*

I agree to operate within facilitation standards and licensing expectations, including ethical conduct, licensing boundaries, and participant safety.
SECTION 3 — DISCLOSURE & CONFIDENTIALITY

Please review and accept the terms to proceed.
Disclosure & Confidentiality Agreement

This facilitator certification provides structured leadership and educational frameworks. Certification does not qualify participants as therapists, counselors, or licensed mental health professionals.

Certification grants permission to facilitate materials only within approved internal contexts. Unauthorized reproduction, resale, or representation beyond certification scope is prohibited.

Participants agree to respect confidentiality of any sensitive information shared during cohort environments.

Participation is voluntary and educational in nature.

Certification does not authorize commercial resale, independent consulting, or paid external delivery of these frameworks without a separate written licensing agreement.

Acceptance into the program requires signing a separate participation and licensing agreement prior to access.
I confirm that I have read, understand, and agree to the certification disclosure and confidentiality expectations.*

I confirm that I have read, understand, and agree to the certification disclosure and confidentiality expectations.
Applicant Signature*
Date*

MonthDayYear
Date
Should be Empty:

Facilitator Certification Application

SECTION 1 — APPLICANT INFORMATION

SECTION 2 — PROFESSIONAL READINESS

SECTION 3 — DISCLOSURE & CONFIDENTIALITY