Master Practitioner Candidate Program Master Practitioner CandidateApplication Form 1Personal Information2Assessing your Readiness (Part 1)3Assessing your Readiness (Part 2) First Name*Last Name*Email* Phone*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Application and Self Assessment of Readiness for Program As we are planning on having a smaller, more intimate teaching team this year, we request that you complete the following form in order to help yourself and us assess your readiness for this intensive program. Please know that if you are not chosen to participate for this year's team, you are welcome to apply again for future teams - or to work with us to develop your Master Practitioner status beyond the scope of the Centre itself. Depending on the number of people who apply for certification, we may not be able to provide immediate feedback about your application. Please be patient with us as we will endeavour to respond to everyone in a timely manner. Please rate your current capacity/level of comfort with holding space for the following:Giving constructive feedback one-on-one*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsReceiving constructive feedback one-on-one*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsGiving constructive feedback in a group setting*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsReceiving constructive feedback in a group setting*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsAddressing conflict*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsSelf-regulating when experiencing intense emotions*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsAttending to self care*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 Comments Balancing your own needs with the needs of the group*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsAsking for what you need*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsIdentifying when you and/or another individual or the group need to pause*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsStepping into a leadership role*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsRecognizing and addressing who needs to be centred in a challenging situation while balancing the needs of the group*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsIdentifying and taking ownership of your shadow, biases, and privileges*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 CommentsCelebrating your victories, strengths, and accomplishments*Scale: 1 (low comfort/capacity) 2, 3, 4, 5 (high comfort/capacity) 1 2 3 4 5 Comments
