Application Form: Group Mentoring & The Art of Facilitation

3-Month Pilot Program with Claudia Cuentas, LMFT

This mentorship is designed for new and emerging psilocybin facilitators seeking to deepen their craft within a culturally grounded, peer-supported environment. Please complete this application form to be considered for admission. Limited scholarships and reduced-fee spots are available in alignment with the Andean principle of Ayni (Sacred Reciprocity).

Please review program policies before applying

Name

First Name

Last Name

Phone

(###)

###

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Location & Time Zone

Current role and organization (if applicable)

Facilitation/therapy/psychedelic work experience (brief description)

Relevant training or certifications:

How many hours of facilitation have you completed to date?

Why are you interested in joining this mentorship?

What specific skills or areas do you want to develop?

How do you envision applying what you learn in your community or practice?

Which of the principles — Ayni, Munay, Ayllu — resonates most with you, and why?

Ayni (Sacred Reciprocity), Munay (Love in Action), and Ayllu (Sacred Community)

Are you available for all scheduled dates/times (bi - weekly, Oct 1, Oct 15, Oct 30, Nov 12, Nov 26, Dec 10 from 5-7 PM PST)

Any accessibility needs we should be aware of?

Are you applying for: Full Scholarship / Reduced Fee (50%)

Please describe your financial circumstances and why support would make a difference.

I acknowledge that confidentiality and community agreements must be upheld during the program.

Yes

I consent to program policies (a ttendance, participation, payment terms).

yes

I understand this is a selective program and completing this form does not guarantee admission.

yes

Submission Date

YYYY