12 Month Healing with nature - Dr. Rochelle Calvert

HEALING WITH NATURE TRAUMA CARE TRAINING PROGRAM REGISTRATION FORM

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list prior training experience (e.g., psychological, trauma, mindfulness, indigenous):(Required)

Please list prior experience with understanding and/or healing trauma:(Required)

Please describe your meditation practice/experience:(Required)

Briefly describe your motivation/reasons for wanting to take this training?:(Required)

What (if any) are your concerns about attending this training:

Are you currently in treatment with a psychologist or psychiatrist? If yes, please explain.(Required)

At the moment are there any circumstances in your life that might affect this training (financial stress, loss of a loved one, illness, substance abuse, depression, relational problems, attempts with taking your life). If yes, please describe(Required)

Is there anything else that you would like for us to know that would be helpful in your attending this training:(Required)

Do you identify as BIPOC?