Application for Journal to the Self®
Instructor Certification Training

I will take the Journal to the Self® Workshop (Stage 1) via:

   ___ audiotape/workbook  or
   ___ with a Certified Instructor in my own community *

Who? _____________________________
City/State ___________________
Start date ___________________
End date ____________________

* separate charges apply; $150 rebate given on application fee.
JTTS Workshop must be completed by June 15 for 2007 Intensive.

1. Name:
   
   
2. Mailing Address:
   
   
3. Phone:
   
   
4. E-mail address:
   
   
5. Occupation and licensure, if applicable:
   
   
6. Geographic areas where you will teach or offer services:
   
   
7. Years as a journal writer:
   
   
8. How do you use your journal?
   
   
9. Journal books read/workshops taken/other study in the field:
   
   
10. How has your own journal process shifted or changed as a result of this study?
    
    
11. When did you first learn about the Center for Journal Therapy and/or Journal to the Self®? How and why did you initially contact us?
    
    
12. Why do you want to take this training?
    
    
13. Have you taught classes or workshops before? When/where/what?
    
    
14. Who will you teach? Where will you find students?
    
    
15. What personal and professional outcomes do you hope for as a result of this training?
    
    
16. Are you presently in psychotherapy? If so, have you discussed your desire to take this training with your therapist? (If not, please do so.)
    
    
17. Are there financial considerations you would like us to keep in mind as we evaluate your application?
    
    
18. Is there anything else you would like us to know about you?
    
    
19. Please sign your application. If submitting by e-mail, please type your name followed by the phrase [digital signature].

ATTACHMENTS:

20. A resume or academic/career profile listing education, employment/work for the past 10 years, any teaching experience.
    
    
21. Two letters or e-mails of reference from associates or colleagues who know you and can attest to your character and why they think you will be successful as a journal writing teacher/facilitator.
    
    
22. Check or credit card payment for $250 as a nonrefundable deposit to process your application and send Stage One materials to you. In the event your application is not accepted, this amount will be returned in full less a $35 administrative fee. Stage One must be completed by June 15 in order to qualify for 2007 Intensive.

Submitting Your Application

You may fax your completed application and its attachments to the Center for Journal Therapy at (303) 985-3903; e-mail it as a Microsoft Word file to training @ journaltherapy.com ; or mail it to:

Center for Journal Therapy
1115 Grant St. #207
Denver, CO 80203 U.S.A.

For More Information

For a comprehensive look at the Center for Journal Therapy, please browse our web site. Be sure to browse the Library and the Instructor Directory.

Questions?

Call 888-421-2298.

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