TitlePlease selectMr.Ms.Mrs.Prof.Dr.Name(Required) First Last Preferred Personal PronounPlease selectThey/them/theirsHe/him/hisShe/her/hersEmail(Required) Enter Email Confirm Email Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Level of Education(Required)Please select all that apply BA/BSc MA/MEd PhD Other Select AllLevel of Education(Required)You selected “Other”. Please specify below: License # Disability StatusDo you have a disability as defined by the Accessible Canada Act? No Yes Your Disability(Required)Please let us know of any accommodations we can make to best support your learning process. We will do our best to reasonably accommodate any requests, however, we may not be able to accommodate all requests. We do not say this to discourage you from submitting your accommodation request but rather to ensure you can also begin to consider alternative options should we be unable to meet your accommodation. If Elsewhere in Canada or the US please specify Contact Number(Required)Alternate Contact NumberWhat is your current profession? Include any area of specialisation:(Required)Where and when did you complete or expect to complete Intermediate III?(Required)Please select a locationVancouverKelownaEdmontonSaskatoonElsewhere in Canada or the USCompletion Date(Required) Please upload a copy of your most recent SEI certificate of completion in JPG or PDF format.(Required)Max. file size: 50 MB.I’ve had a major traumatically-stressing event within the past year.(Required) No Yes I understand that the SE training may trigger past traumas(Required) No Yes Are there any grievances, complaints, or actions pending or upheld against you for misconduct as a professional by any licensing, regulating, or associate body?(Required) No Yes If Yes, please provide details and relevant information you are legally permitted to disclose here:Anything else you would like us to know?:All information submitted will be held in strict confidence. Once we have reviewed your application you will be notified by email of your application status. Somatic Experiencing® International in conjunction with Karuna Services Ltd. reserves the right to approve or deny any application, and/or accept or reject the participation of any person in its sole discretion and in accordance with its policies and the law. I have read and agree to the statement above EmailThis field is for validation purposes and should be left unchanged.