Terrain Advocate Program

Provide your name and credentials.

First Name

Last Name

Title

Credentials

Provide your contact information.

Street Address

Unit #

City

State

Postal Code

Phone Number

Whatsapp Number

Email Address

Yes, I would like to receive email communications.

Please describe your needs.

What is your support system for preventing burnout in doing this type of work and how do you continue to work on your own emotional wellness?

What are your strengths that will assist you in completing this course and becoming an advocate?

What will be the biggest hurdle to completing this course?

There is a strong emphasis on the mental/emotional aspects of the disease process in this program. Are you comfortable with the terrain approach which includes incorporating mental/emotional components of the healing process?YesNoUnsure

Is it important for you to have community support and mentorship after the course is complete?YesNoUnsure

How did you hear about this course?

Please provide the name of the person or organization that referred you.

Please provide the name of the conference or event.

If you heard about this course from a source not mentioned above, please list that source here.

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