Application for the Feeding Your Demons® Certification Program

All information provided in this application is maintained in a confidential manner that is used only to support your certification process.

Name*
First Last
Preferred Pronoun (Optional)
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone
Which time zone are you located in?*
Date of Birth*
MM slash DD slash YYYY
Occupation*
Please indicate which Feeding Your Demons® (FYD) courses you are applying for:*
Please select the track:*
- Secular
- Buddhist
If you chose 2. or 3. above, please specify the prerequisite courses you have taken (e.g. Kapala Training Level I, Kapala Training Level II, FYD Online Course I, etc.) and your progress with the prerequisite assignments and practices (e.g. the number of FYD solo- and/or partner work) you have completed.
Click to view prerequisites »
Are you currently a practicing psychotherapist, coach, or facilitator? Please explain:*
Please specify all relevant licenses and/or qualifications, if any, relating to your work:*
Why would you like to be certified as a Feeding Your Demons® facilitator, and how do you plan to use your certification?*
Do you have any questions about your participation in the program? Please explain:*
Have you ever experienced a mental illness such as depression, anxiety, etc? If so, please explain:*
Have you completed any retreats or online courses with Lama Tsultrim Allione or one of Tara Mandala’s Authorized Teachers? Please specify:*
You may upload additional information here:
Max. file size: 200 MB.
Application Fee (will be applied towards the program price upon approval)
Price:
Total
$0.00
Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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