Application form for training program

?Application Form for Training Program

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Contemplative Therapeutic Practice

 

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All information is confidential.

 

 

 

Personal Details:? Full name, address, telephone numbers, e-mail address.

 

 

Work history:? Give (brief) details of your work history.

 

 

Intention:? Write something about why you wish to attend the program.

 

 

Previous experience:? Give details of your experience of receiving psychotherapy, counselling, bodywork, or group work.

 

 

Spiritual practice:? Do you or have you had a particular spiritual practice?

 

 

Any psychiatric or medical history:? Please give details of any psychiatric treatment or medical conditions.

 

 

Support:? Please write something about what and who supports and nourishes you personally, physically, spiritually and professionally.

 

 

Is there anything particular happening in your life at present/recently that you?d like me to know about?

 

 

Previous talks etc:? Have you attended any of the previous talks/workshops on Core Process Psychotherapy?? If so, which.