Advanced Professional Training in the Intensive Journal® Method

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Advanced Professional Training in the Intensive Journal® Method


Overview | Introduction | Background | Description | Application
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Application for Admission

Please complete the application below. You may attach additional information to this form as necessary. You may attach a copy of your resume if you wish.

Please mail your application to:

Dialogue House Associates
23400 Mercantile Road - Suite 2
Beachwood, OH  44122

Advanced Studies Program Application

    Date____________

A. Name and Address

Name_______________________________________

Address_____________________________________

City ______________State____ Zip code___________

Telephone   Day____________ Evening_____________

E-mail _______________________________________

Best time and place to call ________________________

 

B. Education

List your educational experience (include any part-time or non-degree study).

University/College Degree   Major Graduation Year
       
       
       

 

 

C. Work Experience

List your employment history with the most recent positions first.

Employer  Position Start Date  End Date   Description
         
         
         
         

 

 

D. Intensive Journal Workshops Attended

List below the Intensive Journal workshops that you have attended. Please list no more than 10 programs (a workshop series of back-to-back workshops is one program). If you do not remember the specific dates and places, please describe as best you can. Use the back of this sheet if necessary.

Sponsor City State Workshop Date
         
         
         

  

E. Other Interests and Activities

List other interests and activities relevant to your interest in the Advanced Studies Program.

____________________________________________________________

____________________________________________________________

____________________________________________________________

 

F. Admission Essay

Write a brief essay (maximum of two pages) that summarizes

- your interest in Dr. Progoff's work;

- your reason(s) for applying for admission for admission to the Advanced Studies Program;

- how you use the Intensive Journal method in your own life and how it has affected your life. (Please provide specific examples.);

- how you intend to use your knowledge from this Program;

- why you will be a reliable and accountable representative of Dialogue House.

 

 

G. Personal Reference from a Certified Leader of the Intensive Journal method

Provide the attached reference form to the leader who will complete and send it directly to Dialogue House Associates.

Name of leader________________

If you do not know a leader, please contact Jonathan Progoff to discuss your situation.

 

H. Other Information

Please provide any other pertinent information for your application.

Please mail your application to: Jonathan Progoff, Dialogue House Associates, 23400 Mercantile Road, Suite 2, Beachwood, OH  44122.

If you are accepted in the program, you can then submit the applicable fees. Thank you for your cooperation.

 


 

Personal Reference

Please describe the candidate's qualifications for admittance into the Advance Studies Program for the purpose of becoming a certified leader. (You may attach a typed letter.) Please do not complete this form unless you know the person in depth. Thank you for your assistance.

 

Name of candidate___________________________________

 

Name of leader______________________________________

 

  Excellent Above Average Average Below Average Poor
A. Personal Qualities
1. Overall character          
2.Communication skills           
3. Ability to relate to people           
4. Professionalism          
5. Teamwork          
           

B. Intensive Journal Method

1. Knowledge of the Method           
2. Use of the Method           
3. Interest in the method          
4. Interest in conducting workshops          
5. Belief in the value of the program          
           

C. Overall qualifications for admission 

         

Please explain (C):__________________________________________________

_____________________________________________________

_____________________________________________________

D. Please explain how you know the candidate. _____________________________________________________

_____________________________________________________

 

E. Comments____________________________________

_______________________________________________

 

 

Signature of leader________________________________

 Date____________