Embodied Resilience Application
This form is meant to provide some reflection and insight into your participation in this 12 week somatic healing group focusing on healing from the impacts of trauma and oppression and accessing resilience. Thanks for taking the time to thoughtfully answer all questions. Participants will be notified of their acceptance into the group within a week of application. If group is full, you will be notified and placed on a waitlist. If you have any questions please feel free to email me at brooke@haveheartwellness.com.
Email address *
Name *
What are your pronouns? *
Phone *
What has you interested in Embodied Resilience? What draws you to participate in this group? What are you hoping to transform through your participation? *
How do you identify in terms of race, body size, ability, class, gender, sexuality, etc? What communities are you a part of? *
What has your relationship to embodiment been like in the past? What is it now? *
What has your healing work looked like up to this point? How much intentional healing have you done? *
What is your support system like? How supported do you feel? This may include people, pets, spiritual, religious or embodied practices, meds/supplements, etc. *
How are you in groups? What kind of positive feedback do you get from others in groups? What about negative? How do you take feedback when you receive it? What edges do you anticipate bumping up against in this group? *
Do you have any access needs that I should know about? What helps you feel as safe and present as possible, especially in an online/video context? You're 100% at choice in what you share here. *
This group is a 12 week offering that meets Tuesday evenings June 30th-September 15th. Are you available all of these dates? If not, please explain *
Wise Bodies costs $85/week or $1020. Enrollment is for the whole group only. You are expected to pay the entirety of the group fee regardless of how many sessions you attend. *
There is 1 $50/week space still available exclusively for QTBIPOC applicants. There are also scholarship funds available for QTBIPOC. Are you interested in accessing this space or these funds? Will you be able participate if you can't access these funds?
Various payment plans are available. All participants will be charged a minimum of $85 or your weekly session fee to reserve space. Which would you prefer? *
We will gather for group practice weekly. You will receive homework and practices to be done on your own or with other participants. It is expected that you show up to group on time and ready to practice right at 6:30. *
Embodied Resilience is highly experiential. We will work to actively feel into our bodies every week, often contacting difficult histories. A big part or our work will be to contact resilience in order to hold these histories, AND it is important to know that this is an experiential somatic group.
Clear selection
Our communities are often very small. Do you have any current conflicts I should know about? Are there any people you do not share space with? Please keep disclosures to "headline-level" summaries. I don't need every detail. We can arrange to talk more as needed. *
Brooke Stepp is a certified nutritionist and licensed mental health counselor in Washington. As facilitator of this group, Brooke is not entering into a therapeutic relationship with you. They are serving as a guide, a facilitator, and at times a coach in your own healing. *
Anything else you want me to know?
Submit
Never submit passwords through Google Forms.
This form was created inside of Have Heart Wellness. Report Abuse