Application

Thank you for your interest in the Gestalt Equine Institute of the Rockies. For a quicker response, please fill out all the fields below to the best of your ability.

Please note: In order to be accepted into our certificate program, you must already be a practicing clinician or coach, or in your 2nd year of graduate school for the counseling field. Applicants must also have a basic level of horsemanship. Know that even as a beginner, you may need to take additional horseback riding or horsemanship lessons in order to graduate from our program.

If you have questions or problems with the application, please contact Kimberly at gestaltequine@gmail.com.

Thank you!!

GEIR Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Are you currently a practicing therapist, counselor, or coach, or have you been in the past 2 years? *

What is your current work? *

Please list any earned academic degrees and/or coaching certificates (Majors studied, where they are from, dates). *

Why are you interested in attending the Gestalt Equine Institute of the Rockies? How do you plan to use this training? *

Rate your horsemanship experience 0-5 *

Describe why you answered with the number you did above. What current skills is your answer based off of? *

When was the last time you rode a/your horse? *

How frequently do you ride? *

On a scale of 0-5 (0 being very uncomfortalbe/afraid), what is your comfort level around horses in general? *

Have you (or are you) been in your own personal therapy? If so, briefly share how therapy has helped your awareness or growth. *

Do you have any physical or personal needs we should be aware of in order to support your learning? *

Do you feel nervous or concerned about participating in this training program? If so, about what? *

Please list any previous (or current) post-graduate or special trainings that relate to fields of psychology or equine studies. *

Name and contact number for professional reference. *

Name and contact number for personal reference. *

The above information is true and complete to the best of my knowledge. The Institute has my permission to obtain all necessary information from the references and training institutions 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, and does not indicate acceptance into the program. Should the Institute enroll me and I attend the modules, I may terminate such enrollment at any time and understand that the Institute will retain all monies paid thus far.

Printed signature confirming that you understand the above information. *

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Application

GEIR Application

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Application

GEIR Application

Location

What Our Clients Are Saying

Contact Us

Subscribe Today!