Healing Retreat Application 2024
Thank you for your interest in the Healing Retreat for Survivors of Childhood Sexual Trauma.  This is a detailed application, and so please set aside some time to breathe, walk away and come back, or stretch in between questions, as needed.

All personally identifying information will be kept confidential.  No personal identifying information will be shared with anyone outside of program facilitators. We want to learn more about who you are and how we can best serve you.

The Healing Retreat requires a $50 application fee*.  If accepted to the Healing Retreat, your $50 application fee will be applied to your retreat tuition.  Upon hearing an acceptance from the facilitation team, you will have one week to confirm or decline your participation.  If you choose to withdraw your participation within one week, this fee will be refunded to you.  After one week, your $50 application fee will be donated towards our scholarship fund should you decide not to join us or if we do not hear back from youIf your application is not accepted for this year's retreat, your $50 deposit will be refunded in full. 

*If this fee is a barrier to you applying, please email the facilitation team at survivorshealingretreat@gmail.com. 

Application deadline extended to May 15. The facilitation team will be in contact with you about your application by May 15.  Please let us know if you will not have access to email during this time.


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电子邮件地址 *
Name *
Pronouns *
Physical/Mailing Address (city, state and country) *
Phone number *
Date of Birth *
Gender *
必填
Ethnic/ racial identity
Is there anything you want us to know about your identities or orientation that will help us support you well during the retreat?
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