Step 1 of 3 33% M.E.T.A. Professional Development Training ApplicationName* First Last Pronoun (Example: They/Them, She/Her, He/Him, Ze/Zir) Date of Birth* M.E.T.A. / Hakomi Comprehensive Training Year One Year Two M.E.T.A. Professional Skills Training Hakomi Mindful Somatic Psychotherapy (Module 1) The Re-Creation of the Self (Module 2) Advanced Clinical Maps & Topics (Module 3 M.E.T.A. Experiential Trauma Psychotherapy (Module 4) M.E.T.A. Experiential Attachment Psychotherapy (Module 5) M.E.T.A. Couples Therapy (Module 6) M.E.T.A. Integrative Bodywork Training (Module 7) Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail* Add to M.E.T.A. Mailing List* Yes No Emergency Contact Name:* First Last Emergency Contact Phone:* Education:please check all that apply High School Graduate Some College Bachelors Degree Masters Degree Advanced Degree (Ph.D., Psy.D., M.D., N.D., D.C., etc.) Where / Areas of Study:Previous M.E.T.A. Trainings You've Completed:M.E.T.A./Hakomi Comprehensive Training Year One Year Two M.E.T.A. Professional Skills Training Hakomi Mindful Somatic Psychotherapy (Module 1) The Re-Creation of the Self (Module 2) Advanced Clinical Maps & Topics (Module 3 M.E.T.A. Experiential Trauma Psychotherapy (Module 4) M.E.T.A. Experiential Attachment Psychotherapy (Module 5) M.E.T.A. Couples Therapy (Module 6) M.E.T.A. Integrative Bodywork Training (Module 7) Additional Significant TrainingsWhat, Where, Areas of Study, Applicable Licenses or Certifications:Significant internships, tutorials, apprenticeships, mentorships:What, Where, Areas of Study, Applicable Licenses or Certifications: (please list anything YOU consider a formative factor in your personal or professional development, whether you assisted in brain research at Harvard, or if Aunt Helen taught you fly fishing in Idaho) Licensures, other Certifications, Diplomas, Credentials, etc.What, Where, Areas of Study, Applicable Licenses or Certifications: Please upload a photo here of yourself or attach it to the email separately.Accepted file types: jpg, png, pdf, jpeg.1. Give us a brief summary of your professional evolution as a therapist/counselor:*2. Describe your experience working one-on-one with clients. Include kind of practice, nature of your work, clinical orientation, type of clientele, and the degree of success and satisfaction you feel from your work:*3. Are you currently receiving clinical supervision or consultation:*4. What is your vision or goal for applying what you will learn in this training? How does it fit into your career and life goals:*5. Tell us about your learning style:*6. Please give us a brief commentary on your experience in mindfulness related endeavors, meditation practices and intensives, etc. Let us know what draws you to further study of experiential, mindfulness-based therapy:*7. A significant element of the training will be the creation of a group dynamic that supports a vibrant learning environment. We expect students to interact as adults, to be able to regulate strong feelings and to find collaborative ways to solve interpersonal conflicts. Tell us about your experiences and style as a group member, how you resolve interpersonal conflicts, where you may need help with this and how you see yourself adding to the richness and preservation of the group. Include topics like leadership, extroversion, introversion, how you prefer other to be, difficulties you typically experience, etc:*8. Please let us know about any medical conditions or personal factors that you may have or have had in the past, including psychological diagnosis, abuse or trauma history, suicidality, or other issues that may effect your participation in the training. Feel free to be frank, as none of these by themselves preclude participation in our trainings. However, as this is a training and not a group therapy program, we do expect students to be able to adequately manage their psychological and physical processes, be self-aware, and able to access medical and psychological support as needed:*9. In a paragraph or two, describe what kind of person you are:*10. Is there anything else you would like to tell us that you feel would help us to know you better? Although not required, feel free to submit any materials such as brochures from your career or projects, creative work, etc. that you feel would be valuable to this application process:*Payment Options:*CheckCredit/Debit CardApplication fee is $60. For Credit/Debit Card Payments there will be a 3.0% processing fee included in the cost of the application fee.Application Fee*Check if you agree to pay the application fee.Application Fee*Check if you agree to pay the application fee.Discount Code: If you have a discount code, please enter it here to apply. Total $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.