Unplowed Ground Certified Respite Provider Interest

Unplowed Ground Certified Respite Provider Interest Form

This is for individuals who are interested in becoming an Unplowed Ground Certified Respite Provider. Please fill in your information and we will be in contact with you about next steps.

Name(Required)

First Last

Email(Required)

Phone(Required)

What state are you in?(Required)

I am interested in becoming an Unplowed Ground Certified Respite Provider because:(Required)

Have you completed an Unplowed Ground training previously or are you new to Unplowed Ground?(Required)

How did you hear about this Certification program?(Required)

If other:

I am passionate about helping families with children who have experienced early childhood trauma.(Required)

I understand that I will not be in the role of an attachment figure but a safe respite provider.(Required)

I agree to adhere to the Unplowed Ground principles and practices, and will not teach Unplowed Ground, but point families to King's Ranch for training.(Required)

Is there anything else you would like for us to know?

Please list 3 references along with their contact information.(Required)

Name

Relation

Phone number

Email address

Upload a copy of your resume.(Required)

Max. file size: 164 MB.

I certify that all information I have given is correct.(Required)

I understand that this is an interest form, and does not guarantee acceptance into the Unplowed Ground Respite Certification.

Yes, I understand.

Please Sign:(Required)

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Unplowed Ground Certified Respite Provider Interest