Equine-Facilitated Psychotherapy (EFP) US Application Form

Applicant Name *

First

Last

Email *

Date of Birth *

mm/dd/yyyy

Gender *

Male
Female
Non-binary
Other

Date of Application *

mm/dd/yyyy

Address *

City *

Country *

Zip/Postal Code *

Phone Number *

My preferred payment method is: *

$3,500 Full Tuition upfront
Pay per workshop ($750 per workshop)
I am eligible for the Student Discount

Degrees and Qualification Held: *

Please list Year, Institution, and Degree/Certificate Awarded

Degrees and Qualification Held: *

Please list Year, Institution, and Degree/Certificate Awarded

Degrees and Qualification Held: *

Please list Year, Institution, and Degree/Certificate Awarded

Post-Graduate and/or Additional Training Experience(s) *

Please list: Year, Length of Program, Name of Program

Post-Graduate and/or Additional Training Experience(s) *

Please list: Year, Length of Program, Name of Program

Post-Graduate and/or Additional Training Experience(s) *

Please list: Year, Length of Program, Name of Program

What attracts you to The HERD Institute? *

Please describe your experience with horses (please include any riding experience) *

What do you hope to gain from this training? *

Please provide a Personal Statement about yourself and your experience *

Do you have any special needs or dietary requirements, while you are at the training? (Please check all that apply) *

Vegetarian
Gluten-Free
Nut Allergy
Other

Please use this space to provide any further information you feel may be relevant *

Please email a copy of your most current resumé to info@herdinstitute.com *

I have emailed my resumé
I do not have a current resumé so will email one within the next 5 days
Other

Declaration *

DECLARATION: By typing my name in the Applicant Electronic Signature box above, I declare that all the information I have provided is true and complete to the best of my knowledge and that The HERD Institute has my permission to obtain all necessary information from the references I have listed concerning my past experience and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice from me. I understand that this application does not constitute a contract of any kind. Should the HERD Institute enroll me, I may terminate such enrollment at any time. I have read and agree to the above statement and understand that by entering my name, I agree to the terms.

The Human-Equine Relational Development Institute

Equine Facilitated Psychotherapy (EFP) Application Form