Psychedelic Harm Reduction and Integration Supervision Group Application Form
Please complete this form and the required questions. This supervision group meets in-person from 12:00 to 1:15 p.m. weekly for 12 sessions starting 9/13/18 (Skips 10/4/18 and 11/22/18). Meetings will be held at The Center for Optimal Living (370 Lexington Avenue, suite 500, New York, NY 10017). Investment: $1200.

If you have any questions, please email info@psychedelicprogram.com or call 212.213.8905 x2.

Email address *
How did you hear about this program? *
Your answer
Have you completed the 2-day Psychedelics 101 & 102 Training? Or will you attend the 2-Day Psychedelics 101 & 102 Program in September 2018? *
Your answer
Have you ever provided psychedelic harm reduction or integration services? Please describe the contexts/approaches you have worked with. *
Your answer
Professional Qualifications: Please list highest degree obtained, school, and date of completion. *
Your answer
What are you hoping to gain from this supervision group? *
Your answer
Current employment *
Your answer
Areas of specialization and advanced training (if applicable). *
Your answer
Please provide your name and current date as confirmation that the information above is valid and accurate. *
Your answer
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