Student Application — Psychedelic Studies & Healing Modalities
Please complete this 3-page application. Responses are reviewed with care and kept confidential where indicated.
Personal information
First name
*
Last name
*
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
City of residence
Country of residence
Pronouns
Educational and professional background
Highest level of education completed
Please Select
High school/GED
Some college
Bachelor's degree
Master's degree
Doctoral degree
Trade/vocational certification
Other
Current profession or occupation
Relevant licenses or certifications
Why are you applying to this program?
*
How did you hear about us?
Please Select
Word of mouth/colleague
Social media
Podcast or interview
Web search
Event or conference
Newsletter or email
Other
Experience with psychedelics and altered states
Which of the following have you had personal experience with?
Psilocybin/magic mushrooms
MDMA
LSD/other lysergamides
Ayahuasca/DMT
Ketamine (therapeutic or recreational)
Cannabis (therapeutic intent)
Ibogaine/iboga
San Pedro/mescaline
No personal experience
Prefer not to say
How would you describe the context of your experiences?
Ceremonial/indigenous context
Clinical or therapeutic setting
Recreational use
Self-directed/personal growth
No prior experience
How has your experience with psychedelics or altered states informed your interest in this field?
Have you worked with any other healing or therapeutic modalities?
Breathwork (holotropic, transformational)
Meditation or mindfulness
Somatic/body-based therapies
Plant medicine traditions
Transpersonal psychotherapy
Talk therapy
Energy medicine (reiki, acupuncture, etc.)
None
Mental and physical health
These questions are asked to support your safety and wellbeing. All responses are confidential and reviewed with care.
Do you have a current relationship with a mental health or healthcare professional?
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Yes — therapist, psychiatrist, or counselor
Yes — other healthcare provider
No
Not currently but I have in the past
Are there any physical or mental health considerations we should be aware of?
Do you have a personal or immediate family history of psychosis, mania, or a condition such as schizophrenia or bipolar I disorder?
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Yes
No
I'm unsure
Prefer not to say
Would you like to share any additional context? This helps our team follow up with you appropriately. (Optional)
Intentions and readiness
What is your primary intended application of this training?
Clinical or therapeutic practice
Research
Facilitation or ceremony holding
Education or teaching
Personal growth and integration
Advocacy or policy work
Not yet sure
How familiar are you with the current legal and ethical landscape around psychedelic-assisted therapy?
Please Select
Very familiar — I follow research and policy closely
Somewhat familiar — I have a general understanding
Beginner — I know very little but am eager to learn
No prior knowledge
What are you most hoping to learn or develop through this program?
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Is there anything you're uncertain or concerned about regarding the program?
Logistics and commitments
Preferred learning format
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In-person only
Online/remote only
Hybrid
No preference
How many hours per week can you realistically commit?
*
Please Select
2–5 hours
5–10 hours
10–20 hours
20+ hours
Do you have any financial aid or scholarship needs?
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