Seattle School of Body-Psychotherapy Application
November 2021 – May 2022
Please copy and paste this page and email it to
ayleewelch@bodypsychotherapy.us
along with the $75 application fee
Name & Pronouns
Physical Address
Phone
Current Profession and experience (please include any licensure or certifications).
Past Educational Experience
What is your interest in Body-Psychotherapy and Core Energetics?
Please share something of your family of origin, other aspects of your background, and your own personal therapeutic experiences. Do give us detail in these answers covering any trauma or other important life experiences.
What is/ has your relationship been with substances and / or any addictive behaviors and what have you done about them, how has this worked for you?
Do you have any experience as a participant or facilitator of group therapy?
Please share any other interests or information that you think would be helpful for me to know.
Include three references, their relationship to you and their phone numbers.