Application & Mutual Fit Process
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Professional Background
1. What is your current profession or area of practice?
2. How many years have you been practicing hands-on or manual therapy?
3. What significant manual therapy, osteopathic, visceral, cranial, structural, or related training have you completed?
4. Briefly describe the type of clients you currently work with.
5. What kinds of clinical problems or treatment situations do you find most challenging?
Interest in the Training
6. What is drawing you to this 12-month training?
7. What are you hoping to develop in yourself as a practitioner over the course of the year?
8. What do you feel is currently missing or incomplete in the way you assess or treat clients?
9. What interests you specifically about the Living Systems approach?
Learning and Feedback
10. How do you generally respond when someone gives you constructive feedback about your work?
11. Can you briefly describe a time when feedback changed the way you worked or thought about something?
12. What helps you stay open and curious when you are learning something that challenges what you already know?
13. When you are confused or struggling with something in a class, how do you usually approach it?
Working in a Small Group
14. This training involves working closely and repeatedly with a small group of practitioners. What helps you function well in that kind of environment?
15. What do you believe makes someone a good practice partner?
16. How do you typically handle a difference of opinion with a colleague or instructor?
17. Are you comfortable giving and receiving respectful feedback with classmates?
Yes
No
18. Are you comfortable working with different partners throughout the year?
Yes
No
Personal Responsibility and Boundaries
19. Hands-on learning can occasionally bring up personal reactions or emotions. How do you typically take care of yourself when something personally challenging arises?
20. Do you understand that this is an educational training and not a setting for counseling or personal therapeutic processing, and that if additional support is needed, you are responsible for seeking that support outside the training?
Yes
No
21. Are you comfortable taking responsibility for communicating your own boundaries and respecting the boundaries of others?
Yes
No
Commitment and Fit
22. Are you able to make the training a meaningful priority and attend most or all of the scheduled weekends?
Yes
No
23. Are you willing to practice the material between classes and bring your questions and experiences back to the group?
Yes
No
24. Have you previously received treatment from me or attended one of my classes?
Yes
No
25. As part of the application process, applicants are asked to experience an individual session with me before final acceptance into the program. Are you willing to do this?
Yes
No
Final Question
26. Is there anything about your learning style, communication style, or participation in a hands-on group that you think would be helpful for me to know?
Acknowledgment
I understand that submitting this application does not guarantee acceptance into the 12-Month Training. The application, interview, and individual session are intended to help both Michael and the applicant determine whether the training is a good mutual fit.
I understand and agree.
Signature
*
Submit
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