Power & Praxis Program Application

Welcome to the application for the Power & Praxis Program! This form is designed to help us understand your goals, experience, and alignment with the values of the program. Please complete all sections thoughtfully.

Basic Information

Full Name *

Preferred Name (ifapplicable)

Pronouns

Email *

Phone *

Date of birth *

Personal Background

If other, please briefly describe:

Why are you interested in Power in Praxis at this point in your journey? (250 words or less) *

What do you hope to gain from this program, and how do you plan to apply your certification in the future? (250 words or less) *

Commitment and Availability

This is a 120-hour certification that includes live sessions, asynchronous content, and independent research. Are you prepared to commit approximately 4 to 6 hours per week? *

Yes

Do you have any accessibility needs or special accommodations that we should consider to support your participation? *

Yes

If yes, please describe.

Program Values and Ethics

Do you agree to participate in a learning space grounded in consent, accountability, cultural responsiveness, and kink-affirming values? *

Yes

Do you agree to uphold the program’s values of safety, consent, inclusivity, and accountability throughout your training and future practice? *

Yes

Financial Considerations

How do you plan to pay for the program? *

One-time payment of $2,997

Payment plan (e.g., $499/month)

Will you require an employment reimbursement letter? *

Yes

Additional Information

How did you hear about the CPKP Program? *

Website

Social Media

Referral

Other

Please share which site, social media platform, referral name, or other. *

Acknowledgments

Ethical Pledge:

I agree to uphold the program’s ethical principles, including safety, consent, and inclusivity, during my participation and beyond. *

I Agree

Code of Conduct:

I understand that I must adhere to the program’s Code of Conduct, and violations may result in removal without refund. *

I Agree

Submission

Please review your application carefully before submitting. If you are not able to submit please review your application to make sure you have completed all required questions.

If your application is a match, you’ll be invited to enroll immediately with either pay-in-full or payment plan options. You’ll receive a link to the checkout page and have 3 business days to secure your spot.

If we have questions or need to follow up, we’ll reach out directly. If we determine the program isn’t the right fit right now, we’ll offer alternative resources or future opportunities.

Thank you for your interest in the Power & Praxis Program. We look forward to learning more about you and supporting your journey!