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Cert 1-Application Form
What it is your full name?
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What is your email?
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Where do you live?
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What is your website/professional profile?
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What is your primary training in? Please list
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Training title
- Institution / provider
- Duration (years)
- In-person / online / mixed
Year qualified?
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How long have you been doing consistent client facing practice?
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Briefly describe the type of work you currently do
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Why are you interested in Breathwork Training?
Have you experienced breathwork before? (Conscious Connected Breathwork) If so please share more about context
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Have you experienced breathwork before? (Conscious Connected Breathwork) If so please share more about context
A
Yes
B
No
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What do you sense Breathwork could bring into your current practice?
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This training involves working with intensity, somatic process, and expanded states. How do you currently relate to depth in your own inner work?
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Can you describe a time in your professional work where you felt the work wanted to go deeper, but you did not yet have the tools, confidence, or supervision to follow it?
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How do you typically respond when you are uncertain, stretched, or challenged in your work with others?
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Are you currently in ongoing personal therapy?
Yes / No
If yes: what kind of therapy (no names required)? Please also share what kinds of personal therapy you have has previously.
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Do you currently receive professional supervision?
* Yes / No
* If yes: individual / group / both
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19. Are you willing to engage in additional supervision alongside the training if required?
Yes / No
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19. Are you willing to engage in additional supervision alongside the training if required?Yes / No
A
Yes
B
NO
Why does this training feel relevant now, rather than earlier or later?
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What do you feel you bring to a group learning environment?
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Is there anything you want us to know that hasn’t been covered above?
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