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Application for Trauma Integration Circle
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Email Address:
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First and Last Name:
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Address:
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Cell Phone Number:
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Birthdate:
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1. Why do you want to participate in the program?
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2. Please describe your experience with personal and familial trauma.
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3. Are you willing to commit to participating in this program for six months and attend at least 80% of the sessions?
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4. What are some other programs you have participated in that are trauma related?
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5. Do you have a regular meditation practice?
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6. Describe any triggers, challenges, or habitual pattern that you feel keep you from growing, healing, and integrating, traumatic events from the past?
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7. Are you willing to keep confidentiality about who is in and what is said in our closed group?
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8. What do you need to feel safe in a group setting?
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9. Are you currently working with a therapist?
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10. Do you have any questions or have anything else you would like to share with us?
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