Certification in Sexological Intimacy Coaching

T H E I N S T I T U T E

F O R R E L A T I O N A L H A R M O N Y S T U D I E S

Certification in Sexological Intimacy Coaching - ONLINE

Application Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Phone

Country

(###)

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Website and/or Facebook ID

http://

Emergency contact details (who would we contact for you in the case of an emergency?)

What interests you about training to qualify as a Sexological Intimacy Coach?

What experience or training do you have with embodied practices (such as yoga, massage, meditation, martial arts, Tantra etc)?

What experience or training do you have that could contribute to your work as a Sexological Intimacy Coach?

Do you have access to therapy or supervision if you require support during this training?

What do you think you may find challenging about the training?

How do you envision making use of what you learn in the training?

Please tell us anything you would like us to know about your ethnicity, gender identity and/or sexual orientation:

Please tell us about any physical or mental health issues you may have. This is important for us to know about in order to support you in the learning process:

If you are living with a disability could you please provide a little detail about the disability and how we might support your learning:

If you are living with trauma could you please provide a little more detail on how it currently affects you:

Are there any medications or substances you use?

During this training are you anticipating any significant changes in your life?

If you have any criminal convictions or been subject to any disciplinary proceedings please declare them here or write "none"

Any other information you wish to provide?

During Online Group Study, I understand approximately 25 hours per week of study time are required

I agree

I agree to seek support and to communicate with the teaching team about any issues that I experience that may impede my learning or ability to meet deadlines.

I agree

I give permission for my contact information to be shared with the teacher support team.

This information will be used by your mentors to support you throughout the training.

I agree

Post your unanswered Question here

Name

First Name

Last Name

Subject

Message

Phone

(###)

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We welcome you to post any questions that haven't been answered here and Márcia will send you an email with answers and/or invite you with a booking link to arrange a 15 - minute call with Katie Sarra - Director of Studies or Phoebe Garland - Head of the CSSE Training.