The Sharing Group
FACILITATOR INTAKE FORM
Confidential Information

Welcome to our Application for Facilitator Status for the Indra’s Net Sharing Group. We review your information and conduct an interview via video conference to determine your appropriateness as a facilitator. We ask that you affirm your adherence to the basic structure of the Sharing Group as it is attached to this form. We may ask you to fill out a W-9 Tax form depending on the amount of remuneration you will receive. Hence the request for your SSN. Obviously this does not apply if you are applying from outside the US. In addition to this form, please send a CV/Resume and any licensing certificate you may have. Do remember you do not have to be a psychotherapist to be a Sharing Group facilitator. Also please find following the form below you will be directed to fill out the PCL-90 and the Wellbeing assessments. You will fill these out in the beginning and again at the conclusion of your Sharing Group experience.

Please fill out the following as completely as possible. It is Indra’s Net’s responsibility to carefully select facilitators and we have a responsibility to affirm their ability to conduct sessions with persons who are vulnerable. All provided information is confidential.

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