Facilitator Program Application

Thank you for your interest in the LENSES Facilitator Program! Please complete our program application so that we may get to know you better. We will let you know your acceptance status within 3 weeks of receiving your application. 

First Name (required)

Last Name (required)

Email Address (required)

Mailing Address (required)

City (required)

State (required)

Zip (required)

Country (required)

Phone (required)

Job Title (required)

Organization (required)

Organization Type (required)

Which program are you interested in? (required)

If you are interested in the In-Person Program, please choose the locations you prefer to attend (required)

Tell us about yourself (250 words or less), including relevant educational and professional information, as well as what you are passionate about. What is your professional background? What is your professional vision? Where do you see yourself in 5 years? We will use this information to compile a directory that will be shared with all participants. (required)

What does regeneration and regenerative development mean to you? (required)

What do you hope to learn during the LENSES Facilitator Program? (required)

How did you find CLEAR and the LENSES Facilitator Program?