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Enrollment Questionnaire - Collaborative Course

Thank you for your interest in the Collaborative Course on Interpersonal Psychology. For more information on the course, visit this webpage.

Please fill out this questionnaire to be enrolled in the course.

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Question 1 of 11

Name

Question 2 of 11

Email Address

Question 3 of 11

Please indicate your familiarity with Jay Earley’s work:

(Select all that apply)
A

Read Jay’s book "Self-Therapy"

B

Read additional books by Jay

C

Attended a webinar hosted by Jay

D

Joined an Interactive IFS Group

E

Joined a Group Leader Training

F

None of the above

Question 4 of 11

What motivated you to enroll in this course and what are you hoping to receive from it?

Question 5 of 11

What experience do you have with psychological theory? (none required)

Question 6 of 11

Please indicate which sessions you will attend live via Zoom.

(Note - sessions are 9:30am-11:00am Pacific | 12:30pm-2:00pm ET | 5:30pm-7:00pm UK) 

(Select all that apply)
A

I will attend March 26 live via Zoom

B

I will attend April 9 live via Zoom

C

I will attend April 23 live via Zoom

D

I will attend May 14 live via Zoom

E

I will attend May 28 live via Zoom

F

I will attend June 11 live via Zoom

G

I will not be attending any of the live sessions

Question 7 of 11

In the spirit of collaboration, Jay is looking for participants to offer ongoing feedback to him throughout the course.

 

Please indicate if you have interest in providing any of the below after each session:

 

(Select all that apply)
A

Offering feedback on what it was like for you to do the experiential exercises

B

Offering feedback on his ideas and how those ideas relate to others you know about

C

Trying out using the ideas to support your work with people and giving him feedback on that

D

I'm not able/interested to provide feedback on any of the above

Question 8 of 11

Jay is in need of a Zoom technical support person for each session.

 

This person would manage breakout rooms and offer basic troubleshooting during the live course. In exchange they are welcome to choose 'no cost' when paying for the course.

 

Please indicate if you have the skill and interest for this role. We will follow-up with those interested.

A

I do not have this skillset and/or I am not able to offer support in this way

B

I am able and willing to offer Zoom technical support for some of the live sessions

C

I am able and willing to offer Zoom technical support for all 6 live sessions

Question 9 of 11

Jay is looking for a person with slide and graphic design expertise. 

 

This person would support the course by turning ideas into visually engaging slides that graphically illustrate key ideas. In exchange they are welcome to choose 'no cost' when paying for the course.

 

Please indicate your skill and interest for this role. We will follow-up with those interested.

A

I do not have this skillset and/or I am not able to offer support in this way

B

I have some graphic/slide design experience and am interested to support

C

I am a professional graphic/slide designer and am interested to support

Question 10 of 11

The live sessions will be recorded and shared with registrants. Portions of the recording, including participant videos and voices, may be used for future trainings. Breakout Rooms will not be recorded unless you specifically choose to do so. By clicking this box you are indicating you understand and agree to this recording policy.

A

Yes, I agree.

Question 11 of 11

Anything else you want to share?

Confirm and Submit