HEARTraining Application

Thank you for enrolling in the OI HEARTraining^®.
To complete your Application, please provide the following information:

Personal Information

First name*
Last name*
Street*
City*
State or Province*
Zip or Postal Code*
Country*
Email*
Phone (home)*
Phone (mobile)*
* Required information
Emergency Contact
First name*
Last name*
Phone (home)*
Phone (mobile)*
Please include a picture
A picture of yourself*
Allergies and medical conditions
We do our best to accommodate all food sensitivities and allergies by working with the chef at the residential retreats. Medical conditions and/or allergies are relevant in the unlikely case of a medical emergency. Your informationwill not be shared with your cohort, but will be shared with your faculty, training coordinator and lead mentor.
Food allergies:
Food allergies
- None
I have following food allergies:
Food sensitivities:
Food sensitivities
- None
I have following food sensitivities:
Medical allergies:
Medical allergies
- None
I have following medical allergies:
Medical conditions:
Medical conditions
- None
I have following medical conditions:
I would like to join the following HEARTraining:
Location*
My primary occupation:
Occupation*
Other
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®*
Hakomi*
Sensorimotor*
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 [email protected] 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.
Confirmation
Confirmation*
- 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.
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OI HEART Application

HEARTraining Application

Personal Information

Emergency Contact

Please include a picture

Allergies and medical conditions

I would like to join the following HEARTraining:

My primary occupation:

Please select the highest somatic training level(s) you have completed, if any:

Your experience, if any, with other somatic or professional training:

What is your single biggest challenge in work or practice?

What do you expect to get out of the HEARTraining?

Add a handwritten letter

Confirmation

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