Somatic Stretch Training Application Instructions for ApplyingComplete the entire application and we’ll contact you by phone or email soon. All information you provide in this application will be held strictly confidential. There is a $75 application fee that can be paid once your application has been accepted and you are ready to join the program. If you have any questions please contact us at firstname.lastname@example.orgFirst Name*Last Name*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Home PhoneCell PhoneWork PhoneOccupationAgeEmergency Contact Name and Phone NumberAre you wanting to join for personal or professional reasons?Have you explored any somatic modalities in the past such as yoga, Mitzvah, Pilates etc?If so, what is your favorite modality to practice and why is it your favorite?If applicable, please tell us how long you have been involved with these other practices.Do you have a daily/weekly practice? If so, please provide us with a detailed description.From a student’s perspective, what qualities do you think make a great somatic educator/ teacher?Tell us about your favourite teacher and why s/he impacted youWhat are your personal goals in working with the Somatic Stretch training program?What are your goals as as teacher if you become certified?Are you currently a teacher? If so, for how long and how many classes a week or month do you teach?Are you currently taking any medications? if so, please list them and the condition you are treating.*Are you, or have you been, under medical treatment for any physical or psychological condition? If so, please provide a detailed description.*Are you in addiction recovery, and if so, for how long?*Do you have any physical conditions, surgeries or injuries? If so, please describe*Are you currently pregnant or trying to get pregnant?Captcha Kudos for taking an important and powerful step on your path of health and wellness!