TREE OF LIFE CENTER
Somatic Energy Healing Training Application- APP Level 1
225-235 hour Polarity Therapy Professional Training
We are a Nationally Certified Continuing Education Provider with NCBTMB # 3129991-00
& and American Polarity Therapy Association (APTA) Approved school.
Name _______________________________ Date of Birth _________________
Address____________________________________________________________
Phone’s (cell) __________________________(Other)________________________
Email______________________________________________________________
Occupation__________________________________________________________
NC LMBT Licence #__________________ for Continuing Education
OR Check off all that apply:
I am interested in pursuing the APTA training levels to become a BCPP (Board Certified Polarity Practitioner)_____
I am already a licensed healthcare provider and would like to add Polarity Therapy to what I do________
I plan to take this course for self-care and sharing with family and friends ________
Other____________________________________________________________________________
How did you find out about this Tree of Life Center Polarity Therapy Training?
On a separate sheet or via email briefly answer the following:
A. Why are you interested in studying polarity and what are your intentions or goals with participating in this training?
B. Describe pertinent training, experience, and Energy work or bodywork you have received.
C. Describe your learning needs and preferences to help us support your development.
D. Describe the learning gifts that you can bring to the group.
E. Do you receive or have you received Somatic process-oriented bodywork before?
F. Please describe whether you have personal/medical conditions (physical, emotional, mental) which may affect the quality of participation in classroom activities such as movement and Gentle Energy Yoga/attendance or coursework completion or that could get stimulated in the training environment.
G. Are you willing to reach out for support to a Counselor or Somatic Practitioner if you are needing more processing resources during the training period if things are coming up for you?
H. Describe any resources and supports internally and externally that help you when you are stressed out.
I. Do you have any dates that you are unable to participate in the training dates listed?
Pre-requisite Requirements:
To take our full training you will need to participate in our Intro to Polarity Therapy 1 and Intro to the Chakras & Elements prior to the start of our program to make sure we are all a good fit for one another.
To apply to this program please:
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Complete all application questions and email them to jmdchi@mindspring.com or mail to the address below with a $100 application fee that will go toward your total tuition.
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Upon acceptance into our program, a Deposit of $350 is due by February 1st to reserve your space.
Payments options: -Venmo @JaniceMarie-Durand
or -mail a check made out to Janice Marie Durand or Cash:
Tree of Life Center
Attn. Janice Marie Durand
4316 Bradford Ridge Road
Efland, NC 27243