IPI Psychedelic-Assisted Therapy Training Application
Thank you for applying to the IPI Psychedelic Therapy Training! We're grateful that you are taking interest in psychedelic-assisted therapy. Our program is competitive with limited availability. Before our call we would like to learn more about you and your interest in the program.  

Step 1: Please complete this 3-5 minute application
Step 2: You will be directed to schedule a call after completing this form.

We look forward to speaking with you soon!
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Email *
First Name *
Last Name *
Pronouns
Email Address *
Date of Birth *
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Country *
Mailing Address *
Cell Phone Number *
Work Phone Number *
Education: (Please list your highest degree and area of study) *
Please list all professional licenses with license number,  state(s) issued, and status. You must include active, inactive, restricted or suspended licenses. (In order to qualify for the program you must have one of the following credentials: Professional Clinical Counselors (LPC), Marriage and Family Therapists (LMFT), Clinical Psychologists (PhD/PsyD), Licensed Addictions Counselor (LAC), Clinical Social Workers (LCSW), Pre-licensed therapists (MA), Chaplains (M.Div.), Physicians (MD/DO), Nurse Practitioners (NP)) *
If you are not a licensed or a graduate of a masters - level or equivalent psychotherapy program, please explain below how you have 1000 direct contact hours of mental health interventions.
If you are a medical provider, please list the type of board certification you have?
How did you hear about us? *
Introduce yourself and describe your psychotherapy training, and your current practice setting. *
Describe some of your self-care practices *
Describe, if any, your experience with psychedelic-assisted therapy *
How do you see yourself using the knowledge from the training? *
Why do you want to be a part of a community of practitioners learning psychedelic therapy? *
How do your skills and gifts contribute to the program? *
What most excites you about this program? *
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