Working draft, September 28, 2026. Online form: questions with open answer fields, plus checkboxes. Field types are noted in brackets for Gregory. Questions harvested from Gina's recent scholarship applications and adapted for Cultivate; deeper questions moved to the Facilitator Interview Guide.
Intro text (top of form)
Thank you for your interest in facilitating with Cultivate. This application asks about your training, how you practice, and your own experience with psychedelic healing. Anything you share in writing stays confidential between you and the people who review your application and interview you. There are no right answers here; we're interested in how you think about this work. Our team of guides reviews every application, and you can expect to hear back within a week.
About you
- Full name [short text, required]
- Email [email, required]
- Phone [short text, required]
- Website [URL, optional]
- Modalities you practice [long text, required]
- Training, certification, or licensing relevant to your work [long text, required]
- What you'd hope to offer through Cultivate [checkboxes, required: One-on-one sessions / Circles / Workshops / Other (short text)]
Your own experience
- [Checkbox, required] I have significant personal experience with psychedelic healing and integration.
- Tell us about your experience with psychedelic healing and integration, as much as you're comfortable sharing [long text, optional]
Helper text: If you'd prefer to simply note that you have significant experience and save the details for your conversation with Gina, we support and respect that.
Your work
- What drew you to psychedelic integration work, and what keeps you in it? [long text, required]
- How has your own lived experience shaped the way you accompany others? [long text, required]
- What does integration mean to you, beyond making sense of a single experience? [long text, required]
- Where do you recognize the limits of your capacity as a facilitator, and how do you know when someone needs support beyond what you can responsibly provide? [long text, required]
- How do you support someone's meaning-making without imposing your own interpretation? [long text, required]
- What do you believe can go wrong in psychedelic work, even when everyone involved has good intentions? [long text, required]
- How would being part of Cultivate complement or deepen the work you're already doing? [long text, required]
- In your own words, how do you see your work contributing to the modern village we're visioning? [long text, required]
Our commitment to you (text, shown before the agreements)
Cultivate welcomes applicants of every race, ethnicity, religion, gender, gender identity, sexual orientation, age, ability, and background. We never decline an application because of a diagnosis or health condition. Our decisions rest on your training, your scope of practice, your own experience of psychedelic healing, and the safety of everyone who gathers with us.
Agreements [one checkbox each, all required]
Full wording is in the Application Agreements draft (Claude project doc: application-agreements-draft). Attorney review pending.
- Accuracy of your application
- Confidentiality and use of your information
- Participation and engagement tracking
- Not a substitute for therapy or medical care
- Personal responsibility and assumption of risk
- Legal compliance and harm reduction
- Terms & Conditions
- Privacy Policy and Cookie Policy
- Scope of practice
- Responsibility for offerings you lead (to align with the hold-harmless terms planned for the facilitator agreement)
- Independent practitioner
After submitting
Confirmation message: Thank you. We've received your application, and you'll hear from us within a week. After we review it, you'll receive an invitation to schedule a conversation with Gina.
Open notes
- Non-discrimination statement: added September 28; include in attorney review.
- Confidentiality: application responses need restricted access so only the reviewer and interviewer can see them (Gregory). Include the handling of written answers about personal psychedelic use in attorney review.
- Agreements: update the Responsibility for Offerings item to match the facilitator agreement's hold-harmless and "offered independently" terms once drafted.
- Photo and listing details (photo, bio, rates, member rate) are collected after acceptance, during onboarding.
- Length: eight written questions, so roughly 45 to 60 minutes to complete. Consider marking one or two optional if that feels like too much.