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Worksheet

Somatic Experiencing® Professional Training Program Application (Advance Level)

Thank you for your interest in the Somatic Experiencing Professional Training. We are pleased to welcome you to our online application process. This application will take approximately 30 minutes to complete. 

A few things to note BEFORE you begin the application:

1. You MUST complete the entire application in one sitting. We strongly recommend that if you do need a break, you keep the web page with the application open and return to it.  

2. Applications are processed on a first come, first registered basis. A student's spot is only secured once a payment has been received (either in full or through a payment plan).  

3. There are sections of this application for you to upload supporting documents. If you do not have a Gmail account, this option may not be available to you and as such, you may need to email those documents to us instead. Please note that any delay in sending supporting documents will have an impact on your successful registration. 

4. Once you have been registered for the training you will receive a confirmation email with additional Releases and Consents to be signed and returned PRIOR to the first day of training.  

5. Please be sure to add info@patriciaberendsen.com to your email address book to ensure successful communication with us. 


* Indicates a required question
1. ➜

Full Name *

2. ➜

Preferred Name (if applicable)

3. ➜

Pronouns *

4. ➜

If other, please specify:

5. ➜

Street address

6. ➜

City *

7. ➜

Province *

8. ➜

Country *

9. ➜

Postal Code *

10. ➜

Primary Phone Number *

11. ➜

E-mail Address *

Note: we send ALL information via email, so please provide an email address that you check on a regular basis - and be sure to check your spam folder as well.

12. ➜

Mailing List

Do you want to join our mailing list to receive information about additional workshops, training and programming being offered through our center?

13. ➜

Level of Education *

14. ➜

If other, please specify:

15. ➜

Professional Occupation *

16. ➜

Field of Specialty (if applicable)

17. ➜

Registration Number of Your Governing Body *

18. ➜

Do you have any grievances, complaints, or actions pending or upheld against you for misconduct as a professional by any licensing, regulating or associative body?

19. ➜

If Yes, please provide full details and copies of all relevant information:

20. ➜

Please Upload Your Resume

21. ➜

Please upload most recent SE training certificate

This applies to individuals who are switching to the London, Ontario SE training cohort from another SE training cohort 

22. ➜

Biography *

Please make your responses concise but with enough information for us and the facilitator to know you. 

Please include the following information in your biography:

  • Your current professional practice 
  • Number of clients you see each week 
  • A short statement indicating your primary interest in learning SE® 

23. ➜

Payment Information

The fee for the training is $1725 + HST ($224.25)  

Payments are to be made via our SE Training website, under the Student Portal tab: Home - Somatic Experiencing (SE) Training | London, Ontario (somaticexperiencinglondon.com)
24. ➜

What training are you applying for?

25. ➜

Are you a member of any of the following communities? (Select all that apply)

26. ➜

If other, please specify:

27. ➜

Please be sure to review each of the following sections thoroughly prior to agreeing. Please put your initials after each section.

Please put your initials after each section below.

28. ➜

We reserve the right to cancel and/or reschedule any training classes...

We reserve the right to cancel and/or reschedule any  training classes due to low enrollment prior to the start of the class. Should your class be canceled, you will be notified as soon as possible. A full tuition will be issued OR the funds may be transferred to another class.

29. ➜

All information submitted will be held in strict confidence. Once we have received your completed application packet you will be notified by email of your application status within 7-12 business days. Applications are approved on a case-by-case basis. Patricia Berendsen and Associates Trauma Healing Center of London reserves the right to approve or deny any application without explanation and will provide a full refund. 

30. ➜

Patricia Berendsen (nor SEI) are liable for expenses incurred due to cancellation, including but not limited to airline cancellation fees or hotel cancellation fees.

31. ➜

Due to the depth of the work personal traumas may be triggered during the training. We encourage you to ensure that you have support (whatever that looks like for you) both at the training and after. 

32. ➜

Refund Policy

Cancelling more than 30 days prior to the training: You will receive a full refund minus an administrative fee of $200.  

Cancelling less than 30 days prior to the training: You will receive a 50% refund of your registration fee.

33. ➜

Photography and Video Disclaimer

The Trauma Healing Centre of London reserves the right to photograph and record training sessions (live or in-person). By registering for this event, you understand and acknowledge that photographs and videos with you in them may be taken and used, per the discretion of the Trauma Healing Centre of London. Recordings of SE training is intended for training and development purposes. Photographs may be used in publications and/or marketing graphics. 

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