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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 9

Name

Question 2 of 9

Email Address

Question 3 of 9

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

Question 4 of 9

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

Question 5 of 9

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

Question 6 of 9

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 9

In the spirit of collaboration, Jay is looking for participants to support the course in various ways.

Please indicate if you have interest in any of the below, and we’ll follow up with more details:

(Select all that apply)
A

Offering experiential feedback (provide written and/or recorded responses to Jay from a given exercise)

B

Slide & graphic design (create simple visuals/diagrams that illustrate key ideas)

C

Zoom technical support (manage breakout rooms and basic troubleshooting during live sessions)

Question 8 of 9

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 9 of 9

Anything else you want to share?

Confirm and Submit