PLEASE INCLUDE A $100.00 CONDITIONALLY-REFUNDABLE* APPLICATION FEE, TO BE CONSIDERED.

MAIL TO:
Lawrence Gold
The Institute for Somatic Study and Development
15 Esquina Road
Santa Fe, NM 87508

or pay on-line at http://somatics.com/training.htm

*Fee refunded to candidates not accepted due to limited class size or due to qualification requirements. Fee credited to tuition.

* 1. date

* 2. Application Fee paid?

Fee must be paid to be eligible for consideration and to determine the tuition rate ("early bird" vs. "not-so-early bird").

* 3. personal information

* 4. professional information

* 5. Please rate your level of proficiency.

* 6. What (if any) teaching experience do you have?

* 7. What experience (if any) do you have practicing as a somatic educator (of any school or lineage)? and for how long?

* 8. Please rate your level of proficiency.

* 9. What do you intend to achieve/acquire by taking training in Hanna Somatics Gold?

* 10. In which movement disciplines do you have training and experience (how much)?
(e.g., dance, martial arts, movement therapies, sports, somatic practices, etc.)

* 11. Any physical complaints (how long)?

(Answers to this question may open an opportunity to have those issues resolved during training and/or point to preparation needed prior to training.)

<SIZE=4><B>Have you:</B></SIZE>

* 12. experienced the clinical (hands-on) form of Hanna somatic education?

* 13. practiced somatic exercises? (examples, below)

  yes no
Hanna
Feldenkrais
Hanna Somatics Gold
Rolfing | Movement Integration ("Structural Patterning")
Aston Patterning

* 14. read "Somatics" by Thomas Hanna?

* 15. studied a form of somatic education? which teacher/lineage?

* 16. What other background do you have that complements a professional somatic practice?

* 17. Please feel free to add any other information that would indicate your proficiency in, and understanding of, somatic education.

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