certificate program application - Passion and Presence

Mindful Couples Sex Therapy

Certificate Program

Application

There is a $75 application fee to apply, payable through Paypal.
Your application is not complete without payment of the fee.

Mindful Couples Sex Therapy Certificate Program Application

Personal Information

Name

First

Last

What pronouns do you use?

Address

City

State/Province

Zip/Postal

Country

Phone

How did you hear about the program?

What is your profession?

What are your degrees/credentials/licenses?

What draws you to this training?

If you are a therapist, how would you describe your approach?

Do you work with couples?

Describe how this training fits your professional goals.

Are you interested in AASECT certification?

Note: You must be a resident of the USA, USA Territories, Mexico, Canada, or Israel to qualify.

What other courses/ retreats have you taken on sexuality?

How much experience do you have with mindfulness?

What training (if any) have you had in Hakomi Mindful Somatic Psychotherapy? If none, when will you take the intro workshop? Click here for a list.

How familiar are you with Passion & Presence^®?

I read the book

I attended a retreat

I attended a professional training

Not at all. This is new to me.

Which retreat did you attend?

Which professional training did you attend? Where and when?

Are you interested in Passion & Presence® certification?

Yes

(See qualifications in the FAQ section)

How will you make time for the reading and listening assignments before your peer group?

How will you make time to schedule one practice session between meetings?

Please share anything we should know about your trauma history or triggers. If you've experienced sexual trauma, have you had therapy around it? How likely will you get triggered by sexual material? (i.e., Explicit language, discussing sexual themes, hearing cases, studying sexual trauma, working with your personal reactions to sex, exploring your sexual education).

Should you choose to disclose, please list anything that could impact your experience with and accessibility to this program (E.g., neuro-divergence, health issues, disabilities, impairments).

What else do you want us to know?

Do you want to apply for a BIPOC need-based scholarship?

Yes, I would like to apply.

We strive to get back to you within two weeks. If accepted, you must pay a deposit of $750 and sign our Enrollment Agreement to claim your place in the training. Please note this deposit is non-refundable.

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