PIPs' Mentorship Program Application
Thank you for your interest in PIPs' Launchpad Training Program!

This form gives our team information for your access needs, your goals in the program, and contact information for invoicing.

If you have questions about your application, please contact us at launchpad@principalintimacy.com.
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Contact Information
This will be used to create your invoice and to contact you about the trainning.
Name *
Pronouns
Address (including city and postal/ZIP code) *
Phone Number *
Email *
Course Information
What opportunity are you applying for? *
Required
Do you have a preference for who you'd like to be mentored by? Placements are not guaranteed. 
If you are not matched with your preferred mentor at first, would you be still be interested in us suggesting a different mentor for your growth with in the program?  *
I agree to send an updated CV, long and short bio, recent headshot, and Criminal Record Check (vulnerable sector) or equivalent to launchpad@principalintimacy.com upon acceptance.  *
Please select all areas you have experience and feel confident in.
Investment
All money should be in Canadian dollars. 
As this is a min three month commitment, What would be a sustainable investment for you to contribute for this opportunity? All proceeds go towards admin, our instructors, and further bursary opportunities. Upon acceptance into the program, you will be invoiced for a deposit, and then the remaining amount may be paid at the start of class or in instalments throughout the course. If you cannot make an investment offer, please mark '0' and consider applying for a bursary (later in the form). 

Notes: This amount does not include potential travel costs, supplies, kit requirements related to mentorship. If you are a Canadian citizen, GST will be added to your investment amount. Investment pitches are not taken into consideration for acceptance, so please only offer what is sustainable. 
 *
If you would like to pay in instalments, how many will you need and what amount? Please note, your investment will need to be paid in full within three months of your mentorship start date. 
For energy exchange hours, please describe what you'd like to offer to PIP. This may include administration, social media, material sourcing, resource building, etc.  *
How many hours of energy exchange would you be willing to provide to PIP in exchange for a subsidised rate?  *
Bursary Application
For folks who cannot offer a monetary investment. 
Are you in need/want of a bursary to subsidise your fees beyond what you can offer? *
Required
If you need a bursary, please select which group(s) you identify with. If these are not applicable to you, you will still be considered for support. 
Please offer any context you wish to support your bursary application. 
Mentorship Needs
What would you say are your top 2-3 SMART goals are heading into this process?  *
What are you most passionate about with the work? What gets your heart pumping?
 *
What intimidates you about the work? What are areas you want experience in?
 *
Personal Needs
Do you have any access needs/considerations for your mentorship? This may include boundaries of content, communication preferences, more time for reading materials, etc. *
Are there any further details you'd like to share with the mentors about your learning style/needs/etc.?
Please offer an emergency contact (name, number, relationship). *
Do you have any allergies? Additionally, do you have physical accommodations that need to be considered? *
Media Release + Disclaimers
I consent to being in photos/videos taken over the course of the workshop for the purposes of future marketing and social media. *
If you would like us to tag you in these photos, how should we credit and/or tag you? (Instagram/Facebook)
I understand that every mentorship is different, and this program may take less time or more time than the basic 4-6 month estimate.  *
I understand that Phases 1, 2, and 3 of the Launchpad do not certify me as an intimacy coordinator and/or intimacy director, and that participating may not qualify me to teach the content without further training to augment my knowledge. *
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