Advanced SE Training Application Form

Email

This field is for validation purposes and should be left unchanged.

Title

Name(Required)

First Last

Preferred Personal Pronoun

Email(Required)

Enter Email Confirm Email

Home Address(Required)

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

Level of Education(Required)

Please select all that apply

BA/BSc

MA/MEd

PhD

Other

Level of Education(Required)

You selected "Other". Please specify below:

License #

Disability Status

Do 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 Number

What is your current profession? Include any area of specialisation:(Required)

Where and when did you complete or expect to complete Intermediate III?(Required)

Completion 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

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