Training Application Form

Training Application Form
Thank you for your interest in IPAT’s 7-Day On Country Psychedelic Assisted Therapy Training. Due to the experiential, relational, and immersive nature of this training, places are limited and participants will be selected through an application process to support the integrity and safety of the learning environment. Please answer all questions on this form

Please note: Submitting this application does not automatically secure a place in the training. Applications will be reviewed by the IPAT team to ensure the group is aligned and appropriate for this immersive learning experience.
Applicant Information
Full Name

First NameMiddle NameLast Name
Preferred Name
Pronouns
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Location / Country
Occupation / Current Role
Organisation / Workplace
Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to You
Professional Background
Please tell us about your current work and areas of practice
Are you trained in any therapeutic modalities, healing practices, or facilitation approaches?
Have you completed any psychedelic-assisted therapy or psychedelic integration training previously?
Are you currently working within the Authorised Prescriber model or psychedelic-assisted therapy space in Australia?
Is there anything that may prevent you from being able to work in a healthcare context, such as a criminal conviction or pending investigation?
Motivation and Readiness
What draws you to this training specifically?
What are you hoping to gain, deepen, or explore through this training?
How do you feel about participating in experiential, relational, embodied, somatic, and reflective learning?
Why are conversations about power, privilege, cultural humility, ethics, and right relationship important in psychedelic therapy practice?
What does “relationship to Country” mean to you, if anything?
Are there particular areas of growth, challenge, or learning you feel called to explore within yourself at this time?
Have you participated in group process work, retreats, or immersive trainings before?
Accessibility and Additional Information
Do you have any accessibility, health, dietary, mobility, or support needs we should be aware of to help create a safe and supportive environment for you?
Is there anything else you would like the IPAT team to know about you or your application?
Consent and Agreement
Confirm understanding of the training format
Confirm deposit and fee terms
Confirm participation commitments if accepted
Confirm training suitability
Acknowledgement of consent and agreement
Consent to be contacted about application status
Full Name

First NameMiddle NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Training Application Form

Applicant Information

Emergency Contact

Professional Background

Motivation and Readiness

Accessibility and Additional Information

Consent and Agreement