Name
*
First Name
Last Name
Email
*
Phone
*
Country
(###)
###
####
Birthday
*
MM
DD
YYYY
Instagram Handle
If someone referred you to this training, please let us know who so we may thank them:
1. Why do you want to join this training?
*
2. Do you have experience holding space for others? If yes, please let us know in what way, for how long, and any other details you’d like.
*
3. Do you have experience intentionally working with psychedelics? If yes, please let us know in what ways (microdosing, full-dose journey, etc), how many times you’ve worked with the medicine, or for how many years. If you’ve never worked with psychedelics before or have only had recreational experiences, please let us know.
*
4. What would you like to receive from this training?
*
5. How do you see yourself using this training?
*
6. Are you ready to invest in yourself and your future as a Certified Intentional Microdosing Practitioner?
*
Yes, I am feeling deeply called to this work.
I am not in the position at the moment, but may revisit this in the future.
7. Is there anything else you would like us to know?
8. If you are accepted into this training and complete the training requirements, how would you like your name to appear on your Intentional Microdosing Practitioner certificate?
*
9. These statements are true and I am honestly representing myself through my application.
*
Yes
No