APPLICATION FORM
Rupture and Repair: Strengthening Bonds
for Endurance, Stamina, and Resilience

Presenters:
Leticia Nieto, PsyD, TEP &  Daniela Simmons, PhD, TEP

Four (4) consecutive Fridays; Twelve (12) hours
Dates: July 9, 16, 23, 30, 2021

This 4 week long training module, consisting of a total of 12 hours, will have limited seats.

Our preliminary research shows that interest in attending is high.

We ask that you submit the following form - an application for attendance, and answer a few questions on it.



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Email *
First and last name *
Country, state *
What are your current learning goals and learning edges?  What are you most interested in learning or practicing in this space? *
We are planning an environment with an ethic of action-to-encounter rather than large group discussion.  Are you willing to work things through in action (rather than discussion/debate) if any issues emerge? *
Will you commit to co-creating a space of kindness and respect?
A copy of your responses will be emailed to the address you provided.
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