Application Form - Specific Course (not full program)

This form is for first time Embodied Neurobiology students interested in registering for an individual course, or applying for the supervision group. If you are applying for the full program (2020-2022) click here.

Name(required)

Date(required)

Address(required)

Email(required)

Phone(required)

Professional Affiliations(required)

What are your Dance/Movement experience/interests? (required)

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

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

What questions do you have about the training process at this point?(required)

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

Please specify which course you would like to register for.(required)

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

CEU

Supervision

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

Embodied Neurobiology

Advanced Clinical Training in Experiential Therapies

Application Form – Specific Course (not full program)