The Strozzi Institute Somatic Coach Certification Program Application

Strozzi Institute
Somatic Coaching Certification Program
Application

After enrolling and/or completing the in-person foundation course, Embodied Transformation, please complete this application for the Strozzi Institute Somatic Coach Certification Program (SISC).

After you submit your application, you will receive an email confirmation that your application was submitted successfully.

Your next step will be to set up an Enrollment Interview with the Enrollment Director. You can schedule that call at this LINK.

If you are need of general information about the program and have not yet completed or enrolled in Embodied Transformation, please schedule a general consultation with the Enrollment Director at this LINK.

Participant Information

First Name

Last Name

Phone Cell (Primary)

Address

Address 2

City

State

Zip Code

Country

Embodied Transformation (formerly Embodied Leadership) taken in person is the prerequisite and foundational requirement for SISC. Online Strozzi Institute coursework can not be considered. Please provide the month and year you fulfilled this in person course requirement.

Program Application

Which cohort are you interested in joining?

Which other courses have you previously taken with Strozzi Institute?

Are you currently working as a Coach?

IF you are currently working as a Coach, are you certified through the International Coaching Federation (ICF)?

IF you are not currently ICF certified, do you want to be ICF certified?

IF you are already working as a Coach, where did your receive your coach training?

IF you are already working as a Coach, what type of coaching do you offer? (check all that apply)

N/A - Not currently working as a coach

Executive

Organizational/ Teams

Life/ Personal Development

Leadership Development

Diversity, Equity, Inclusion and Belonging (DEI/B)Other

Who do you serve in your coaching practice? If you would like to shift that, who do you want to serve?

Have you received coaching?

Have you received somatic coaching?

Have you received somatic bodywork?

Have you participated in other healing or personal transformation work? IF no, please reply with "no" . IF "YES", what type?

SISC is a transformational program. What types of support do you have in place in your life? (check all that apply)

Therapist

Coach

Family

Friends/Community

Have you engaged in DEI/B development, or other training or work around race, class, gender and equity?

What is inspiring you to enroll in this program at this time?

Personal growth

Professional coach development

Other

How do you imagine you will utilize this coaching certification?

Start a somatic coaching practice

Integrate somatics into your current coaching practice

Offer somatic coaching inside of your current organization

Not sure yet

Other

What would you like us to know about you? Please limit to 200-300 words.

Demographic Information

These demographic questions are optional. By gathering this data we are able to better understand who is participating in our courses.

With which race/ethnicity do you identify? (Optional)

Black / African Descent

First Nations / Indigenous

Pacific Islander

Latinx

MENA - Middle Eastern / North African

South Asian

East Asian

White

What gender pronouns do you use? (Optional)

Select all that apply

She / Her / Hers

He / Him / His

They / Their / Theirs

Another

With which of these class identities do you currently identify? (Optional)

Select all that apply

Poor / Working Poor Class

Working Class

Middle / Professional Class

Upper Middle / Upper Professional Class

Upper Class (New Money)

Upper Class (Inherited)

Another Class

Submit

Form Not Submitting?

If your form is not submitting, it's most likely due to an error in one of the fields. Please scroll up and look for the red exclamation mark to find where you need to correct the entry. If you're still having trouble submitting the form please email courses@strozzinstitute.com.