OI HEART Application Thank you for enrolling in the OI HEARTraining®. To complete your Application, please provide the following information: HEARTraining Application First name*Last name*Street*City*State or Province*Zip or Postal Code*Country*Please select oneUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweEmail* Phone (home)*Phone (mobile)** Required information Emergency ContactFIrst name*Last name*Phone (home)*Phone (mobile)*I would like to join the following HEARTraining: Location*Please select oneBurlingame, CADallas, TXHonolulu, HIIstanbul, TurkeySan Diego, CATucson, AZMy primary occupation:Occupation*Please select onePsychologistPsychiatristTherapistMarriage CounselorSocial WorkerChiropractorBodyworkerPhysical TherapistTCM PractitionerAcupuncturistHealerPhysicianSurgeonDentistNurseMidwifeMindfulness CoacYoga IinstructorClergySpiritual TeacherMilitaryPoliceFire & RescueFirst ResponderProfessorEducatorTeacherStudentPersonal CoachConsultantEntrepreneurSocial EntrepreneurPhilanthropistBusiness ExecutiveManagerSales ProfessionalSelf-EmployedNon-Profit EmployeeGovernment EmployeeSocial ActivistProfessional in the ArtsOther Please specifyOther Please select the highest somatic training level(s) you have completed, if any: It is not a requirement to have participated in a somatic training program. Somatic Experiencing®*Please select oneSEPSE graduateSE Advanced ISE Intermediate IIISE Intermediate IISE Intermediate ISE Beginning IIISE Beginning IISE Beginning INoneHakomi*Please select oneCHTCHPComprehensive Training graduateProfessional Skills Training graduateHakomi for Bodyworkers graduateNoneSensorimotor*Please select oneCertified Advanced PractitionerSP Level IIISP Level IISP Level INone Your experience, if any, with other somatic or professional training: A college degree or equivalent professional experience is required to attend the training. Brief description* What is your single biggest challenge in work or practice? Brief description* What do you expect to get out of the HEARTraining? Brief description*Add a handwritten letter In addition to filling out and submitting this application, please send a handwritten letter answering the below questions. Please scan your handwritten letter or photograph it with your camera or smartphone and email it to firstname.lastname@example.org with the subject line “Handwritten Letter.” In your letter please answer the following questions: Why would you like to attend the HEARTraining? What are you bringing, personally, to the HEARTraining? Please share any other information you feel may be important for us to know as you contemplate your experience in the HEARTraining. ConfirmationConfirmation By submitting this application, I certify that all the information included in this application is true and complete. I acknowledge that Organic Intelligence® reserves the right to approve or deny any application, revoke approval at any time, and approve or deny the participation of any person, in its sole discretion, with or without cause, and in accordance with its policies and the law. I understand and acknowledge that for enhanced learning purposes each HEARTraining will be recorded and will be made available to HEARTraining students as an additional learning tool, and that class recordings will be securely stored. By submitting this application I authorize Organic Intelligence to record the classes I attend. This iframe contains the logic required to handle AJAX powered Gravity Forms.