Dance As Medicine Facilitator Training Application Form
Please answer each question with honesty and detail
Email address *
Full Name *
Your answer
Phone Number *
Your answer
Address *
Your answer
Date of Birth *
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Emergency Contact (Name, Phone, Email, Relationship to you)
Your answer
What interests you in Dance Facilitator Training? *
Your answer
Tell me about your experience with dance as a healing / spiritual practice? Include any classes, workshops or trainings you have attended and with whom. Mention any books you have read. *
Your answer
Please provide a description of your current dance practice.
Your answer
How long has dance / movement been a practice for you?
Your answer
What are your goals and objectives for taking this program? Do you have long-term vision once you have completed the training?
Your answer
If you plan to teach others, what does that look like?
Your answer
What is the highest vision you would like to create in this training?
Your answer
What is a mythical character that represents your inner dancer? (maybe a character from a storybook, movie, play)
Your answer
Is dance your spiritual practice or a part of your spirituality? If yes, tell me more…
Your answer
How has dance supported you to overcome challenges or problems in your life?
Your answer
What are your greatest strengths and how are you able to use them?
Your answer
What motivates you?
Your answer
How do you like to be supported and cared for? What does support look like? (Think about another training or workshop you’ve attended, what worked or did not work in the way the facilitator supported your process or any challenges you might have experienced.)
Your answer
Do you have any other commitments that could keep you from being 100% present on this journey? (a job, community service, family, etc.)
Your answer
How committed are you? (10 being fully committed, 1 being not able to commit at all.)
If you could change that to any number at all, what would it be?
Your answer
What would have to happen in your life for that to be true?
Your answer
What attracted you to this training? How did you find out about it?
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What do you want to get most out of this training?
Your answer
Describe your current physical health and indicate any challenges which would inhibit your participation in physical activity at this time?
Your answer
What else do you want me to know?
Your answer
Thank you for your time in completing this application form. You will hear back from me soon. ~ Hope Corbin, Ekstasis Dance
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