What name do you prefer to go by?
Date of Birth *
Street Address *
City *
State *
Zip Code *
Email *
Cell Phone Number *
How did you hear about this training? *
Gender: How do you identify? * Select One Woman Man Non-binary
What is your sexual orientation? Select One (not required) Asexual Bisexual Gay Heterosexual Lesbian Pansexual Queer None of the above
Which of the following race group(s) do you consider yourself a part of? * American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
Please describe your ethnic identity/heritage. *
September 6th & 7th Attendance Preference: * Virtual or In-Person? In-person Virtual
October 4th & 5th Attendance Preference: * Virtual or In-Person? In-person Virtual
November 1st & 2nd Attendance Preference: * Virtual or In-Person? In-person Virtual
December 13th & 14th Attendance Preference: * Virtual or In-Person? In-person Virtual
If you selected "Other" on the question above, please explain. *
Tell us a bit about about your experience in the above programs you participated in. *
Tell us what you learned in your group experience *
What three words would you use to describe your presence in a group setting? *
This training will include learning how to attend to a variety of stories of harm including and not limited to the harm of white supremacy, white nationalism, stereotypes, and biases we and others have towards different people groups, racism and spiritual abuse. Do you feel you can engage these topics with a spirit of openness, curiosity, and respect for your fellow participants and coaches? Do you feel you have a willingness to see areas of growth for you in these areas and the area of your own cultural identity? Please explain. *
What have you learned about your own story and how that influenced how you relate to others? *
What are you hoping to get out of the Trauma Focused Narrative Group Training: Telling A Tru(er) Story Training? *
What kind of work are you in and how might you desire to utilize trauma-informed narrative work? *
Please provide the name or designation of the license that you hold (ie. LCPC, LCSW, etc.). *
Please provide your license number for the licensure that you hold. *
Please let us know the community or communities you work with or would like to work with.
Please describe how you hope to use the learnings from this training to benefit this community or communities.
Is there an amount that you are able to contribute to the training? (minimum $400)
If yes, which training(s) have you taken with us?
Donation Amount $50 $100 $500 $1,000 $3,000 I would like to contribute more. Please contact me directly.
