Ecstatic Mysticism Online Only Application

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What is your full name?* This field is required.As per your passport.
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What is your email?* This field is required.
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What is your phone number?* This field is required.
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What is your date of birth?* This field is required.
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What is your nationality?* This field is required.
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What is your city and country of residence?* This field is required.
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What is your passport number?* This field is required.
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In this program, we will be working on the Mighty Learning Networks online platform and will have all of our theoretical and experiential classes delivered via Zoom (with recordings if you cannot make the classes live). Do you have any accessibility needs in order to join our online learning community? If so, how can we assist you in your learning?* This field is required.
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Please share what interests you in the Ecstatic Mysticism online only program.* This field is required.
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The cost per pathway for this program is $4,500 USD. If you'd like to do the introduction it is an additional $1,500 USD, and this is optional. You may ask more about the online introduction in your interview process. You are welcome to take anywhere between 1 to 3 pathways. If you take all 3 pathways, you are able to do a Masters and/or Phd with Ubiquity University. Do you currently have the means to be able to comfortably commit to the financial aspect of the online program?* This field is required.
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Please click which pathway(s) you are interested in taking. You may only choose 3 out of the 7.* This field is required.
Psychedelic Medicine
Indigenous Wisdom & Modern Entheogenic Practices
Integrative Psychotherapy
Death
Liminality - Madness and Mysticism
Web of Life - Deep Ecology and Systemic Theory
Sexuality & Eroticism
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How did you find out about Ecstatic Mysticism? If you were referred, can you include by who?* This field is required.
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Please include a recent photo of yourself.* This field is required.
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