Working draft, September 28, 2026. Online form: questions with open answer fields, plus checkboxes. Field types are noted in brackets for Gregory. Deliberately lighter than the facilitator application. The integration-plan questionnaire comes later, during onboarding, and isn't part of this form.
Intro text (top of form)
This short application helps us understand whether Cultivate is a good fit for you right now, for your own wellbeing and for the people you'd be joining. There are no right answers, and you don't need to have your experience sorted out. Anything you share stays confidential between you and the team of guides who review your application. You can expect to hear back within a week.
About you
- Full name [short text, required]
- Email [email, required]
- Phone [short text, required]
- Do you live in or near Santa Fe? [radio, required: Yes / No, but I'm here regularly / No]
- How did you hear about Cultivate? [dropdown, optional: A practitioner or facilitator / Gina's practice / A friend / A gathering or event / Online search / Other (short text)]
Emergency contact
- Name [short text, required]
- Relationship to you [short text, required]
- Phone [short text, required]
- Email [email, optional]
Helper text: Please choose someone other than yourself: a person we could call if you needed support during a Cultivate gathering. We hope never to use it, and we'll only reach out if it would help you.
System (Gregory): flag the entry if the contact's phone or email matches the applicant's.
Your experience
- When was your most recent psychedelic experience? [radio, required: Within the past month / One to six months ago / Six months to a year ago / More than a year ago / I haven't had one yet and am preparing for one]
- What's bringing you to Cultivate right now? [long text, required]
- What would you like from your membership? [checkboxes, required: One-on-one support with a practitioner / Weekly integration circles / Getting to know others doing this work / Learning and resources / I'm not sure yet / Other (short text)]
- Is there anything you'd like us to know so we can support you well? [long text, optional]
- Are you currently in crisis or feeling unstable? [radio, required: No / Yes / I'm not sure]
Helper text, shown if Yes or I'm not sure: Thank you for telling us. Someone from our team will call you [within one business day: confirm]. If you need support right now, you can call or text Fireside Project's peer support line at 623-473-7433 (daily, noon to midnight Mountain Time), or call or text 988 at any hour. If you're in immediate danger, call 911.
System (Gregory): a Yes or I'm not sure answer immediately alerts Gina and a backup guide, and the same support information appears on the confirmation page. See the Crisis Follow-Up Protocol.
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 only on whether Cultivate can offer you the right support right now, and on the safety of everyone who gathers with us. If you need an accommodation to take part, tell us in question 4 and we'll do our best to make it work.
Agreements [one checkbox each, all required]
Full wording is in the Application Agreements draft (Claude project doc: application-agreements-draft), items 1–8. 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
- Participation agreement for Cultivate gatherings, kept on file with your emergency contact (see the Participation Agreement draft)
After submitting
Confirmation message: Thank you. We've received your application, and you'll hear from us within a week. Once you're accepted, you'll set up your monthly membership.
Open notes
- Preparing members: yes, people can apply and create a plan for themselves before their first psychedelic experience (Gina, September 28).
- Question 4: kept optional and open-ended; no question about therapists or health (Gina, September 28).
- Non-discrimination statement: added September 28; include in attorney review.
- Crisis question (question 5): added September 28. People who answer Yes or I'm not sure get a phone call from the team, following the Crisis Follow-Up Protocol. Callback timeframe to confirm.
- Participation agreement wording: drafted September 28 (see the Participation Agreement page).
- Confidentiality: application responses need restricted access, as with the facilitator form (Gregory).
- "How did you hear about Cultivate?" helps show how people arrive, including from Gina's practice site.