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Professional Training Application Form

Please take a few moments to fill out our registration form. We will follow up with a confirmation email within 48 hours.
Thank you!

First Name *
Last Name *
Date of Birth *
City and state where you live *
Email Address *
Phone Number *
Please attach a photo where your face is visible.
Maximum file size: 5 MB
Accepted formats: .JPG, .PNG. Max. upload size: 5MB
Which training module are you applying for? *
Which Hakomi intro workshop did you attend and when?
Why are you interested in this training? *
(300 words max)
What is your highest level of education?  *
(50 words max)
Do you have any relevant licenses or certifications? *
(50 words max)
What is your current professional situation? Do you have experience in the helping professions? *
(300 words max)
Have you done or are you currently doing individual or group psychotherapy? If yes, can you tell us more?
(type of approach, duration, and your experience with it, 300 words max)
Are there any other experiences you have had in the field of personal growth that you would like to share with us?
(300 words max)
What are your strengths when working in groups? What about your areas of weakness? *
(300 words max)
Anything else you want to tell us about yourself? *
(300 words max)