WORKING WITH GROUPS AND TEAMS FORM To which Program are you applying? (select one) Gestalt Training Program (GTP) Working With Physical Process (WWPP) Group Intervention Training Program Working with Groups and Teams Email Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Primary * (###) ### #### Secondary (###) ### #### Age Sex/gender with which you most closely identify * Prefer not to answer Male Female Race American Indian/Alaska Native Asian Black/African American Hispanic/Latino Native Hawaiian/Other Pacific Islander White Two or more races Prefer not to answer Highest Level of Education * High school diploma Some college Associate's Bachelor's Master's Doctorate Business/Organization Position Occupation * Business Owner Coaching Counseling Education Human Resources Law Management/Administration Medicine Nursing Organizational Consulting Psychology Religion/Ministerial/Clergy Social Work Other If other, please describe How did you hear about the training program? * Colleague E-mail Flyer Friend/Family Member GIC Faculty Member Social Media Website Other If other, please describe Were you referred to the training program? * Yes No If so, by whom? What Gestalt experience have you had? What group coach or facilitation experience have you had? Please list the titles, program sponsors/leaders and date of completion of any postgraduate or special training experiences (Gestalt or other). Why have you chosen this program and how does it fit your needs? * Share highlights of your experience and accomplishments. * Describe any major challenges or crises that might affect your participation. Do you have coaching experience? Continuing education (CE) you are seeking * None Counselor Social Work OPA-MCE (Ohio Psychologists Only) APA (Non-Ohio Psychologists) License # If you are seeking continuing education (CE), please enter your license number. References Reference 1 Name First Name Last Name Reference 1 Email Reference 1 Phone (###) ### #### Reference 1 Country Reference 2 Name First Name Last Name Reference 2 Email Reference 2 Phone (###) ### #### Reference 2 Country Please share any accommodations you require (e.g., ASL interpreter, service animal, ramp-accessible parking). Thank you for your application. Please select your workshop/training program below to begin the payment process. Featured A Gestalt Approach to Working with Groups and Teams, Module 2 (PROGRAM TEMPLATE) Hidden Figures: Helping couples discover underlying patterns in their communication A Gestalt Approach to Working with Groups and Teams, Module 1 Gestalt Institute Leadership Development (GILD) Writing Better: Enriching Your Writing Process Neuroscience and the Art of Gestalt: Enhancing Relational Effectiveness Men's GEW - Gestalt Experience Workshop Creative Expression: Going Deeper with Your Coaching Clients The POWER of Resistance: A Gestalt Approach Hidden Figures: Helping couples discover underlying patterns in their communication.
