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Please fill out the sections below:

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* 1. Contact Information:

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* 2. Are you applying to be a Practicing Facilitator?

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* 3. Are you applying to be a Witnessing Painter?

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* 4. If you don't participate as a Practicing Facilitator, are you willing to be a Witnessing Painter, and are you able to commit to attending all 12 weeks?

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* 5. Is it your intention to become a facilitator of process painting, or is there another reason you’re interested in the Practicum?

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* 6. Which of the following Painting Experience activities have you participated in, or are currently participating in? (Approximate number of times and with whom?):

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* 7. Are you currently facilitating process painting or have you facilitated in the past?  If so, give a brief explanation of your experience, including timeline, frequency, number of participants, whether online or in person facilitation.

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* 8. Are you available to participate weekly in the January 17th - April 24th, 2025 Practicum?

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* 9. What else would you like us to know?

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