Program Requirements

1. Applicant is 18 years or older. 2. Applicant has fluency in English. 3. Applicant has GED, high school diploma or more. 4. Applicant is able to work in the United States.

I meet all of the program requirements.

Name *

First Name

Last Name

Birthday

MM

DD

YYYY

Preferred Start Date

January 5th, 2026

Highest Level of Education

High School Diploma

Undergraduate Degree

Graduate Degree

Doctorate

Please qualify the following statement: I have strong boundaries developed in my personal and professional life.

Option 1

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Please qualify the following statement: I am a good listener and don't interrupt to share my own thoughts when witnessing another.

Option 1

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Where are you at in your own healing journey?

I feel like I have come full circle, I know how to work with my personal triggers and feel ready to hold neutral space for others.

I have been working on myself for a while, I have a ways to go but I feel like engaging this work will be good for my own health and sovereignty, I look forward to arriving in a place where I can help others.

I wish to engage this training for personal growth and healing, not to become a practitioner.

How empowered do you feel to use your voice?

I am comfortable and confident speaking my truth.

I am growing in this area and demonstrate more capacity to speak my truth than I used to.

I struggle to speak my truth and often feel as though I can not share what I really feel.

I understand that classes run on Monday and Wednesday mornings from 9:15am-1:30pm for three 12 week trimesters. I understand that this is a clock hour program and that my attendance is required unless there is a true emergency.

I can make the time commitment to classes.

I am unable to make a full commitment to attending classes.

I understand that the clinical portion of this work is required and that patrons of the SWI clinic are relying on student practitioners. I agree to regular attend the clinic shifts that I choose.

I agree to be fully committed to clinic.

I am unsure of my capacity to be fully committed to clinic.

How do you wish to pay for your training?

I wish to make a one time payment with 20% off.

I wish to engage a monthly payment plan.

I am still evaluating my ability to pay for the training.