Application for the

Trauma Informed Consulting & Coaching Certificate Program - 2024

with Thomas Hübl, Amy Elizabeth Fox, and Special Guest Faculty

Please complete and submit the application form below to tell us a bit about your background and interests. It should take about 20 minutes to complete the application. Short answers of 1-2 paragraphs are preferred.

Please answer all required questions and submit the entire form.

Personal Information

Upload your photo

Max. file size: 50 MB.

Please provide a “headshot” photo of you alone, in which you are looking straight into the camera. You must submit a photo as part of your application. If you have trouble with uploading the image, then you will be asked to email it in order to complete your application.

First Name(Required)

Last Name(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone (mobile)(Required)

Phone (landline)

Professional Experience & Training

Please explain the kind of work you do (coaching, facilitation, team intervention, business mediation, CHRO/HRD), the organizational or societal context of your work and the way in which you hope this training can support your professional expression.(Required)

Formal Education - Describe level & degree received, including any now in progress(Required)

List professional certifications or training you have completed or participated in related to transformational change work (most importantly, any training in human development, interpersonal skills, organizational development)(Required)

List professional certifications or training you have completed or participated in trauma healing or collective trauma facilitation (if applicable).(Required)

Please describe any further background or experience that is relevant to your work as an organizational leader or coach.(Required)

Personal Background

What is your personal experience with therapies or healing modalities?(Required)

What is your experience with contemplative, spiritual or religious practices and traditions?(Required)

Describe any personal development programs or workshops that have been important for you.(Required)

Motivation

Why do you feel called to this training at this time in your own professional journey?(Required)

What are your goals for your own development in applying to be part of this training program?(Required)