Mentis Nova

Oregon Psilocybin Facilitator Training Course

Admissions Application

Acadia Professional Learning

admin@acadiaprofessional.com
(503) 963-7913
www.acadiaprofessional.com

Please Read Before Proceeding:

Requirements for enrollment in this course:

Must have a high school diploma or equivalent
Must be 21 years of age or older

Requirements for licensure in the State of Oregon:

The two requirements above
Ability to pass a criminial background check

Please note: You do not have to meet the state requirements for licensure to take this course, but you will NOT be able to apply for a license in Oregon if you do not meet ALL the listed requirements above.

Practicum Requirements

In order to successfully complete this program, you must complete your 40 hour practicum requirement IN PERSON either at an APL sponsored practicum or at a licensed service center with whom you have made arrangements for practicum. APL guarantees your ability to complete practicum through its practicum dates but cannot guarantee the availability or the cooperation of licensed service centers in Oregon for independent practicum placement.

2027 Spring Facilitator Training Cohort Important Dates

1st day of class: March 4, 2027

All work submitted by: June 4, 2027

APL Practicum: Thursday to Sunday, [or_practicum_start_date] to [or_practicum_end_date] in Portland, OR

2027 Spring Facilitator Training Class Times

Tuesday and Thursday 5:00pm - 8:00pm on Zoom

2027 Spring Facilitator Training Tuition

Course with In-Person Practicum: $5,900.00*

*This tuition assumes payment using ACH direct debit through Square payment processors. If a student elects to pay their tuition balance (after application and enrollment fees) with a credit/debit card, there is a 3% credit card transaction fee that is added to the total tuition ($177.00). If a student elects to pay using ACH debit, there are no fees.

Acknowledgements before beginning the application

I have read and understood the requirements for enrollment in this course*

Yes

I have read and understood the requirements for licensure in Oregon*

Yes

I have read and understood the practicum requirements*

Yes

I have read and understood the important dates for my cohort*

Yes

I understand that my $50.00 application fee is non-refundable*

Yes

I understand that if accepted and I choose to enroll in this program, I can pay my tuition balance using direct ACH payments through Square with no fees or pay using a credit/debit card with a 3% transaction fee applied*

Yes

Acadia Professional Learning does not discriminiate in administions on the basis of sex, age, race, color, ethnic orgins, or sexual orientation.

Personal Information

First Name*

Last Name*

Address*

Email*

Phone Number*

Date of Birth*

Please upload a photo of a government issued ID that clearly shows your birthday*

Photo or PDF, up to 10 MB. Encrypted on upload and visible only to admissions staff for this course.

How did you hear about our program?*

If you chose other, tell us how you heard about our program

Have you ever applied to this program before?*

Yes

Have you ever served in the US military?*

Yes

Emergency Contact Information

EC First Name*

EC Last Name*

Emergency Contact Phone Number*

Education Information

Occupational Information

Are you currently employed?*

Yes, 35+ hours per week

Yes, less than 35 hours per week

No, not at this time

Retired

Please list any professional licenses or certifications you currently carry

Interest Expectations

Please describe your motivation and interest in pursuing the Psilocybin Facilitator Training Course. Include any personal or professional experiences that have influenced your interest in this field, including your level of experience with psilocybin mushrooms.*

Please describe your goals and expectations for completing the Psilocybin Facilitator Training Course. What do you hope to achieve or gain from this program?*

Information and Acknowledgements

I intend to apply for acceptance in the following program:

2027 Spring Facilitator Training by Acadia Professional Learning

All applications must submitted through this online form before the application deadline for any cohort. If you are having difficulty with your application, you can email admin@acadiaprofessional.com with questions.

Applications will not be considered complete until the $50.00, non-refundable application fee has been paid online below.

2027 Spring Facilitator Training Enrollment Deadline

February 28, 2027

2027 Spring Facilitator Training Start Date

March 4, 2027

Acknowledgements and Signature

By signing below, I affirm that the information provided in this application is true, accurate, and complete to the best of my knowledge.

I understand that my application will not be considered complete until the $50.00, non-refundable application fee is paid.

I understand the requirements for admission into this program and also the requirements for licensure in the State of Oregon.

I understand that if I do not complete enrollment before the start date to which I am admitted, I may need to reapply for admission and pay the application fee again.

Signature

Full Legal Name

Please continue below to use your credit card to pay your application fee securely through square.

Once you have submitted your application and paid the fee, we will process the information and let you now about acceptance within 3 business days.

2027 Spring Facilitator Training Application (Oregon)