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Application: for Experiental or Combined Delivery
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Application: for Experiental or Combined Delivery
Application: for Experiental or Combined Delivery
katharineknapp
2022-06-02T15:36:42+00:00
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Your Contact Information
Name
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First
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Phone
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What time zone are you located in?
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Workshop Application
Which experience are you interested in?
SEP Personalized Experiential Delivery of SSP
SEP Virtual Group Experiential Delivery of SSP: 12 session package
SEP/SSP Virtual Group Case Consulting for Combined Delivery
SE/SSP Individual Case Consulting for Combined Delivery
How did you hear about this workshop?
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Why are you interested in this group?
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A prerequisite of this cohort is that you are a somatic experiencing provider or student. How many years have you been practicing SE?
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In what role do you work?
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Therapist
Somatic Provider
Bodyworker
Healthcare Provider
Other
Other:
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If trained as mindfulness or somatic provider what type? What are your certifications? If Somatic Experiencing trained, what faculty have you trained with?
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Are you trained beyond the foundational 3 year SE training? If so, list your additional SE training.
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Are you trained in SSP (year when completed training)?
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Contraindications for this experience: please check off any of the following that apply to you:
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I do not experience any of the following descriptions.
active suicidal ideation
active bipolar disorder
lack of emotional support
dangerous living environment
active addiction or eating disorder
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