Embodiment Essentials Registration

To register please fill out the application form below. You will then receive an email with the information needed to pay your $250 deposit (plus 5% fee) to complete your application. The remaining balance is due upon acceptance.

Contact Information

Name *

First

Last

Address *

City *

State *

Zip *

Country

Phone *

Email *

Experience

Please upload a PDF brief resume listing your occupational and educational experience

File Upload

Click or drag a file to this area to upload.

If you are unable to upload your resume please email it to to complete your application.

Application Questionnaire

Please briefly answer the following questions. This will help us to get to know you and your particular interests / needs related to this program. (Please provide at least one paragraph per question.)

What is your current profession and what interests you about this program? *

Please briefly describe your experience in the fields dance, movement, and/or somatic movement practices / bodywork. Be sure to include any specific study of anatomy/kinesiology. Also include any background in mindfulness, social-emotional learning, conflict resolution, or other educational approaches. *

What are your personal and professional objectives regarding this program? How do you see this enhancing your life? *

At this time are you potentially interested in the longer Teacher Training Certification Program? What are your goals in having a Certification to teach this material? *

Please briefly describe your physical, emotional, & spiritual health. Are you being treated professionally at present (alternative medicine, MD. Psychotherapy, etc?) *

Comment on your learning style regarding: cognitive learning, learning through movement and touch, learning individually and in group settings. Include any special needs you will have during the program. *

Are you familiar with online learning and using the Zoom platform? *

Are you familiar with Susan's book, The Embodied Teen: A Somatic Curriculum for Teaching Body-Mind Awareness, Kinesthetic Intelligence, and Social and Emotional Skills? *

How did you hear about Embodiment in Education? *

Will you be using outside funding (grants, professional development funds from a university, etc) to fund your tuition for the Embodiment Essentials Course? *

Anything else you want to share?

OPTIONAL, but very helpful: Are there any individuals or institutions that you know who would be interested in receiving information about this program? Please include mailing addresses or emails.

Emergency Contact *

Please provide a name and phone number

Program details

The Embodiment in Education workshop is an intensive educational program. Our intention is to provide a safe environment for learning among all the participants. As an intensive program that works with the body, intellect, emotions and spirit, we recognize that some people may find certain aspects of the program to be challenging. Through each individual's willingness to learn through movement and touch, to take responsibility for his or her personal health and safety, and to respect the other participants, everyone in the workshop can share a full, rewarding educational experience. This workshop is not meant to replace medical or psychological services. Our policy is to enroll qualified students without discrimination on the basis of race, religion, sex, national origin, age, physical handicap, political affiliation, or sexual orientation.

Registration Agreement (Please read in full before checking the box.) *

I have carefully read the above paragraph and the full course description and I fully understand its procedures and requirements, including tuition fees, media waiver, refund policies, and payment deadlines for the program. I agree to add a 5% service fee if I choose to pay by Paypal, each time I submit a payment. I also understand that no refunds will be issued once the full payment is made, and no partial refunds will be made for missed portions of the workshop, and that recordings of missed classes will not be made available. I declare under penalty of perjury that all of the information I have written as part of my application to the Embodiment in Education program is true and accurate. I understand that photo, video, and / or audio documentation from this course may be used by Susan Bauer for marketing and educational purposes, and agree to sign a waiver of media rights upon acceptance in the program, in the form of a Participant Agreement Form, in order to complete my registration.

Payment

You will receive a confirmation email after registering with a link to make your deposit in order to complete your application.

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