Application Form - Individual Course

This form is for first time Embodied Neurobiology students interested in registering for an individual course, or applying for the supervision group. Registration will be confirmed after a phone call if you are a first time student.

This application is NOT for the full program. If you are applying for the full program click here.

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Name

Date

Address

Phone

Professional Affiliations

What are your Dance/Movement experience/interests?

Have you taken any Dance/Movement Therapy coursework? If yes, what/where/who/when?

How did you hear about Dance/Movement Therapy? Please describe your interest in the subject.

Where do you hope to practice/work with dance therapy in the future?

Is there anything else you would like us to know about you?

Are there any questions you have about the training process at this point?

Please specify which course you would like to register for.

Are you registering for Alternate Route credit? Select supervision if applying for the supervision group.(required)

YES I am registering for Alternate Route credit.

NO I am not registering for Alternate Route credit.

I am applying for supervision.

Thank you. We will get back to you soon with a response.

Embodied Neurobiology

Advanced Clinical Training in Experiential Therapies

Application Form – Individual Course

Thank you for your response. ✨