2023 Psychedelic Assisted Therapies Certificate Application

Certificate in Psychedelic-Assisted Therapies

2023 Program Application

Thank you for your interest in Naropa's Certificate in Psychedelic-Assisted Therapies! Below is the official application for our 2023 program. Please read each question carefully before responding, paying special attention to the Integrity Agreements and Conduct Policy. The Naropa University Certificate in Psychedelic-Assisted Therapies is designed for advanced professionals working in related therapeutic areas such as mental health counseling, medicine, nursing, chaplaincy, social work, and other licensed practice areas. Please review the Application Process & Policies before beginning your application.

Our deposit deadline for program enrollment (April 5) has now passed, but applications for the waitlist are still being accepted through April 10. The deposit deadline for any applicants admitted from the waitlist will be April 12. With this understanding, we encourage interested applicants to apply.

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Agreements

I have reviewed the program’s Application Process & Policies information in full, including the stated eligibility criteria.*

I understand and agree

I understand that I will be evaluated and given feedback on my development over the course of the program, and that I may be assigned additional work to complete if I am not meeting required competencies.*

I understand and agree

I understand that Naropa’s Certificate in Psychedelic-Assisted Therapies includes an expectation that I will commit to a regular contemplative practice (e.g. meditation or another mind-body discipline) for the duration of the training.*

I understand and agree

Integrity Statement

Participants in Naropa’s Certificate in Psychedelic Assisted Therapies program are expected to embody right relationship with psychedelics, plant medicines, and the communities surrounding each. This includes personally exemplifying safe and responsible behavior around substances of all kinds, acknowledging widespread abuses of power within this space and actively working to remedy them, adhering to the law, never misrepresenting oneself, and only practicing within the scope of one’s training.

Naropa requires that trainees within this program refrain from using our physical spaces, such as retreats and classrooms, or our digital spaces, such as learning platforms and email threads, to procure or distribute controlled substances of any kind. We recognize that some participants of this program may have existing connections to underground therapeutic or spiritual practices involving psychedelics. In service of the safe expansion of both the larger psychedelic movement and Naropa’s Center for Psychedelic Studies, we ask that trainees support Naropa’s existence in an exclusively legal space by refraining from using our community as a source of referrals to underground activities. Trainees will also be required to sign an agreement stating that they will not use such substances, including psychedelics and cannabis, outside of training contexts during our three program retreats. *

I understand and agree

Conduct Policy

The Naropa University Certificate in Psychedelic-Assisted Therapies is a post-graduate level training for advanced professionals working in relevant therapeutic areas, including mental health counseling, psychiatry, chaplaincy and social work. Participant conduct is therefore expected to reflect the professional standards commensurate with advanced training in these fields.

As a part of the educational design, aspects of this program may be challenging both personally and intellectually. While one’s physical safety is paramount, some emotional/psychological discomfort may be expected as a natural part of any growth and educational process. Should difficulties or conflicts arise regarding the program, participants should first seek to resolve the issue with the help of program staff. In alignment with Naropa values, the program is committed to the philosophy and methodologies of restorative practices and social justice in addressing conflict and conduct concerns, when feasible. The intention in all circumstances is to assess impacts, repair harm, and use conflict as an opportunity for growth.

Should issues arise wherein participant conduct significantly impacts successful program delivery, we will first seek to resolve the issue by requiring a meeting with relevant program staff, followed by a meeting with faculty co-director(s) if needed. If the conduct continues, we will elevate the issue for full review by program leadership and relevant advisory committees as needed. Following review and implementation of formal restorative process(es) when feasible, subsequent instances of continued impactful conduct will result in consideration for dismissal from the program.

Significant impact to successful program delivery includes but is not limited to behaviors that: present an imminent threat to health, safety, or security; repeatedly disrupt the educational experience of others; impinge upon others’ rights, property, or achievements; or are detrimental to the mission, operations, and/or interests of the University. Under no circumstances will discrimination, harassment or bullying be tolerated, and such behaviors may lead to immediate dismissal from the program. Paid tuition will not be refunded in cases of dismissal due to conduct issues.*

I have read the conduct policy in its entirety I understand and agree

Your Information

Legal Name (First and Last)*

First Name

Last Name

Preferred Name(s)

First Name

Last Name

Pronoun*

Other Pronoun

Date of Birth*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone*

Email*

Website (If Applicable)

Education & Licensure

Please list your education, licenses, and professional certifications, including the state you are licensed in.*

What is the status of your professional license(s)? Active, inactive, probation, unlicensed? Please list for each relevant license.*

Active Inactive Probation Unlicensed

Briefly describe why your license has been inactive or is currently inactive.*

Has there ever been a complaint on your license? If yes, please describe.*

Has your license ever been suspended or placed on probation? If yes, please describe.*

What is the name of the licensing board(s) with which you are licensed or registered? What is your license/registration number(s)?*

Training

How many total estimated hours of psychotherapy, counseling, bodywork, medical care, or spiritual care have you provided to date?*

What percentage of the above estimated hours were you conducting individual psychotherapy, counseling, or professional spiritual care for adults?*

Please briefly describe your experience and number of years spent working with trauma and/or PTSD in a healing, or therapeutic capacity.*

How many hours of personal psychotherapy have you undergone as the recipient?*

Do you have experience providing psychedelic therapy? If yes, please describe.*

Have you completed a MAPS-led MDMA-Assisted Therapy training program?*

Yes No

Please briefly describe your experience working with non-ordinary states of consciousness. This can include psychedelics and plant medicine but also breathwork, meditation, yoga, trance, hypnosis, shamanic work, dance/movement, and many other modalities. While answering, please be mindful of sharing any sensitive information to exclude specific details about where or when psychedelic experiences may have taken place. *

Please describe the population and demographic you serve in your current work, including to what extent you serve historically-underrepresented communities.*

Please choose your preference of apprenticeship-model training modality. (This list reflects current options in development for the certificate program and is intended to gauge interest, not a guarantee of placement).*

Ketamine Breathwork

Essay Questions

1. What inspires you to be a provider of psychedelic-assisted therapy? What skills, commitments, and values do you bring to the field of psychedelic care? *

2. What role do you think power, privilege and oppression play in your work? Describe your commitment to dismantling harmful systems of oppression, beginning with your own inner work. *

3. Are you currently committed to a contemplative practice(s)? If so, please describe the practice, including how long you have been practicing and why it is important to you. Please also describe how you understand contemplative practice as a resource for psychedelic-assisted therapy.*

4. Describe your strengths as well as your growth edges that you would bring as a trainee in this program.*

5. Please watch this 15 minute video by Chacruna Institute, “Chacruna Debunks 6 Racist Myths from the Psychedelic Community.” Choose one myth articulated in the video and then explain how you are working to better understand and disrupt its harmful impact on yourself and others in your community.*

6. Is there anything else you would like for us to know about you and your interest in Naropa’s Certificate in Psychedelic-Assisted Therapies?

Scholarship Essay for Historically-Underrepresented Groups

With generous support from donors, partner organizations, and related charitable initiatives, we offer various types of financial assistance, including Justice, Equity, Diversity and Inclusion (JEDI) Scholarships, as well as support for specific program aspects, such as select Apprenticeship Training Retreats, in an effort to support program access for a diverse and dynamic cohort.

As part of Naropa’s commitment to help promote diversity, equity, and access in the emerging field of psychedelic studies, the Certificate program awards JEDI Scholarships for trainees from historically-underrepresented groups. Historically-underrepresented groups include but are not limited to Black, Indigenous, and people of color (BIPOC), LGBTQIA+, military service members and veterans, persons with disabilities, and those experiencing economic marginalization with demonstrated financial need.

To be considered for our limited scholarships and financial assistance, please describe how your participation in this training will enhance the diversity of this emerging field. Members of historically underrepresented groups and those with related experience are welcome to apply for JEDI Scholarships:

BIPOC

People who identify as Black, Indigenous, or person of color (BIPOC) or Person of the Global Majority including those of Indigenous, African, Asian American and Pacific Islander (AAPI), Latine, Southwest Asia and North Africa/Middle Eastern and North African (SWANA/MENA), and other multiracial descent.

LGBTQIA+

People who identify as lesbian, gay, bisexual, transgender, questioning, intersex, asexual (LGBTQIA+) or other gender and/or sexual minority.

Military Service/Veterans

Active military service members, including Reserves, and military veterans.

People with Disabilities

People affected by or living with disabilities, chronic illness, and/or neurodivergence. Describe your qualifications for services or protections under the Americans with Disabilities Act (ADA), or if you otherwise identify as an individual with disabilities

Socioeconomic Accessibility

People whose self-reported income is in the lowest income bracket and experience economic marginalization. We are aware that multiple considerations can impact socioeconomic accessibility, including household size and number of dependents, expendable income, access to generational wealth, and debt to income ratio.

Please include a personal written statement of financial need, include any specifics that may help us evaluate and determine your potential financial assistance. Some examples of optional information you may include:

Any calculations relating to verified income minus expenses monthly/annually to demonstrate specific financial needs, or provide a statement of economic hardship.
Information about your current employment status: student, employed full-time, employed part-time, seeking employment, etc.
Information regarding your experience with structural oppression, and/or work experiences with those experiencing systematic oppression.

Acknowledgement

Naropa recognizes that individuals who identify as BIPOC, LGBTQIA+, and/or have been otherwise marginalized may experience mental, emotional, and/or somatic responses to describing the nature of your experience. We encourage you to take care of yourself as you reflect on and express the sentiments that you want us to understand about your professional and personal experiences. Self-care can look like taking breaks between questions, stepping outside for fresh air, or moving your body to release any tension that may arise in the application process.

Scholarship Essay

Video Submission

Prospective trainees are required to submit a 3-minute role-play demonstration video responding to the following scenario: A client from a marginalized community tells you that they were hurt by guidance that you offered in a therapy session. What would be important for you to consider? How would you respond? Please record yourself responding as you would respond to the client in this situation.

Video Upload Instructions

Please follow the instructions below to submit your video. Incorrectly submitted videos will not be reviewed.

Video Length: Videos must be no longer than 3 minutes. Videos that exceed this time limit will not be reviewed.
Video File Type: Your video must be in one of the following file formats: HEVC, MP4, MOV, MKV. Please make sure that your video file meets these requirements before uploading.
File Naming Convention: Label your video file as follows: Last name_First name.File Type. Example: Doe_John.mp4. This will help us efficiently identify your submission.
Contact Information: Before uploading your video, please enter your first, last name, and email address in the corresponding fields. Make sure that all information is correct and up to date.
Uploading Your Video: There are two ways to upload your video:
- Drag and drop your video file into the upload field, then click the "Upload" button.
- Click the "Choose File" button to browse and select your video, then click the "Upload" button.
Finish Your Upload: Please wait until the upload progress bar disappears, and is replaced by the text "Uploaded" before proceeding to the next page or submitting your application.

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Documents to Attach

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Please upload copies of any licenses or certifications you hold (select number of uploads)*

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