Name *

Address *

Have you been to a previous workshop of mine? If so, please share which one. *

If you have not been to a workshop, please let me know how you came upon my work. *

If you have not been to one of my workshops, please share a brief history of the inner work you have done. *

What are you currently doing to support your mental, emotional, physical and spiritual health. Share a bit about your practices. *

The middle passage can be marked by great disruption or can be a slow and almost invisible slipping into disconnection and disharmony. Please share what you are willing to about this period of your life. Has there been a single major disruption or life altering event or multiple co-occurring disruptions? A disruption can be a major catalytic trauma or a transitional crisis, often multiple co-occurring challenges arise, examples include: loss of a parent, significant health scare, perimenopause, identity crisis, divorce, launching of a child or children, etc… *

What dream have you not yet fulfilled? Feel free to be as ridiculous as you want here. *

How would you describe yourself in a few sentences. Include gifts, strengths and opportunities for growth? *

If any and all things are possible -what would successful completion of the 2027 middle passage workshop look and feel like for you? *

Are you able to commit to the full year of programming? (The one on one session and live workshop are mandatory if accepted. The virtual group sessions are important and participation in them is correlated with the success of the program for all involved. The occasional absence is totally acceptable and anticipated. Please check your schedule to determine if you can make all or most of the sessions before submitting the application.) *

Workshops of this nature can bring up emotionally challenging material. What does your current support system look like? *

I acknowledge that this workshop is psycho educational and in no way creates a psychotherapist patient relationship between me and the facilitator Kasey Crown.

I acknowledge that despite efforts to protect my privacy, any information disclosed in this application is shared digitally at my own risk.

After you submit your application you'll go straight to checkout to purchase the workshop. Your card will be charged only after your application is accepted.

Application:

WellSoul + In goop Health