Application for Healing the Healer retreat package

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this brief CONFIDENTIAL application so we can understand where you’re at on your path. I am able to take no more than 9 participants, so please fill out the form thoroughly and honestly. If it seems like you are a good fit, I will reach out to you with a letter of acceptance! If it seems like we are not a match, we will reach out to you with some helpful resources and possible next steps for you.

(Please contact nate@grouptherapycentral.com if you have any questions. I am happy to help!)

Email *

Email address (again) *

Your First and Last name *

Your current work setting *

Are you able to take part in BOTH retreats (Northfield and Cabarete)? *

Yes

Maybe

Briefly describe your current struggles with burnout and/or compassion fatigue. *

What is "calling you to" the Healing the Healer retreats. *

What else would be helpful for me to know about you. *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of grouptherapycentral.com. Report Abuse

Forms